title: Residual and Progressive Aortic Regurgitation After Valve-Sparing Root Replacement: A Propensity-Matched Multi-Institutional Analysis in 764 Patients.
abstract: BACKGROUND
  Residual/progressive aortic regurgitation (rAR, pAR) after valve-sparing aortic root replacement (V-SARR) can lead to reoperations. We sought to characterize risk factors of mild rAR and pAR after V-SARR in a multicenter cohort. The effect of additional cusp repair on valve function was analyzed using propensity matching.
  
  
  METHODS
  A total of 1,015 patients after V-SARR were identified with (n = 288, 28%) or without additional cusp/commissure repair (n = 727, 72%) at four cardiac units in Germany. A total of 764 patients fulfilling transthoracic echocardiography follow-up-criteria comprised the study cohort. Logistic regression was used for risk factor analysis with endpoints rAR, new onset AR, and pAR. t tests and analyses of variance were used for between-group differences. The effects of additional cusp repair on valve function were studied comparing propensity-matched quintiles.
  
  
  RESULTS
  The incidence of rAR was 29%, with influencing factors aneurysm size (p = 0.07) and preoperative aortic valve function (p = 0.08). It was found more often among nonsyndromic patients (34% vs. 14%; OR, 0.4; p < 0.001). Progression of rAR was detectable in 30% after a mean of 4.3 years. The progression rate of rAR ∼ 0.3 grades per patient-year within the first 5 years. When quintiles identified by propensity score were compared, additional cusp repair was linked to new onset AR (p = 0.016) while it was not linked to rAR (p = 0.14) or pAR (p = 0.5).
  
  
  CONCLUSIONS
  The incidences of rAR and pAR are considerable after V-SARR. Patients should be operated on before large aneurysms are present. New onset AR after an initially good functional result is more likely after an additional cusp repair, while rAR and pAR are not influenced by cusp repair.
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany. Electronic address: fabian.alexander.kari@universitaets-herzzentrum.de.
authors.forename: Fabian A
authors.initials: FA
authors.lastname: Kari
authors.affiliation: Sana Heart Surgery Stuttgart, Stuttgart, Germany.
authors.forename: Kai-Nicolas
authors.initials: KN
authors.lastname: Doll
authors.affiliation: Sana Heart Surgery Stuttgart, Stuttgart, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hemmer
authors.affiliation: Sana Heart Surgery Stuttgart, Stuttgart, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Liebrich
authors.affiliation: Department of Heart and Thoracic Vascular Surgery, University Hospital Lübeck, Lübeck, Germany.
authors.forename: Hans-Hinrich
authors.initials: HH
authors.lastname: Sievers
authors.affiliation: Department of Heart and Thoracic Vascular Surgery, University Hospital Lübeck, Lübeck, Germany.
authors.forename: Doreen
authors.initials: D
authors.lastname: Richardt
authors.affiliation: University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.affiliation: University Heart Center Hamburg, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Detter
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Siepe
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany.
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D016022:Case-Control Studies; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059351:Organ Sparing Treatments / Q000379:methods*; D057216:Propensity Score; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012092:Replantation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome