title: Survival and freedom from aortic valve-related reoperation after valve-sparing aortic root replacement in 1015 patients.
abstract: OBJECTIVE
  The aim of this study was to characterize mortality and aortic valve replacement after valve-sparing aortic root replacement (V-SARR) in a multicentre cohort.
  
  
  METHODS
  Between 1994 and 2014, 1015 patients had V-SARR with (n = 288, 28%) or without cusp/commissure repair (n = 727, 72%) at the centres of Lübeck (n = 343, 34%), Stuttgart (n = 346, 34%), Hamburg (n = 109, 11%) and Freiburg (n = 217, 21%), Germany. Comparative survival of an age- and gender-matched general population was calculated. Log-rank tests and multiple logistic regression were used to identify risk factors.
  
  
  RESULTS
  The mean follow-up was 5.2 ± 3.9 years. Cumulative follow-up comprised 2933 patient-years. Early survival was 98%. NYHA status and aneurysm size were predictive of death during mid-term follow-up (P = 0.025). Freedom from aortic valve replacement was 90% at 8 years, with the type of V-SARR (root remodelling, David II) being a risk factor (P = 0.015). Bicuspid aortic valve (P = 0.26) and initial valve function (P = 0.4) did not impact reoperation. The need of additional valve repair (cusps/commissures) was not linked to reoperation: freedom from aortic valve replacement at 8 years was 84% if cusp repair was performed versus 90% if V-SARR alone was performed (P = 0.218). Marfan syndrome had no impact on survival or on aortic valve replacement.
  
  
  CONCLUSIONS
  Mid-term survival of patients after V-SARR is comparable with that of a matched general population. The regurgitant bicuspid aortic valve is a favourable substrate for V-SARR. Prophylactic surgery should be performed before symptoms or large aneurysms are present to achieve optimal mid-term outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany 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; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012086:Reoperation; D012092:Replantation / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic valve regurgitation; Aortic valve repair; Bicuspid aortic valve; Valve-sparing aortic root replacement