title: Early and Late Outcomes Following Valve Sparing Aortic Root Reconstruction: The ANZSCTS Database.
abstract: BACKGROUND
  Valve sparing aortic root reconstruction (VSARR) has become an alternative to traditional aortic root replacement with a valved conduit. There have been various modifications but the two broad types are aortic root reimplantation and the aortic root remodelling procedure. We present the early and late outcomes following valve sparing aortic root reconstruction surgery in Australia.
  
  
  METHODS
  We reviewed the ANZSCTS database for patients undergoing these procedures. Preoperative, intraoperative and postoperative variables were analysed. Multivariable regression was performed to determine independent predictors of 30-day mortality. We also obtained five- and 10-year survival estimates by cross-linking the ANZSCTS database with the Australian Institute of Health and Welfare's National Death Index.
  
  
  RESULTS
  Between January 2001 and January 2012, 169 consecutive patients underwent VSARR procedures. The mean age of the study population was 54.4 years with 31.4% being females. Overall, nine patients (5.9%) died within 30 days post procedure and five patients (3%) had permanent strokes. However, out of 132 elective cases, only five patients died (3.8%). Independent predictors of 30-day mortality were female gender [OR 5.65(1.24-25.80), p=0.025], preoperative atrial arrhythmia [OR 6.07(1.14-32.35), p=0.035] and acute type A aortic dissection [OR 7.71(1.63-36.54), p=0.01]. Long-term survival was estimated as 85.3% and 72.7% at five- and 10-years, respectively.
  
  
  CONCLUSIONS
  Along with an acceptable rate of early mortality and stroke, VSARR procedures provide good long-term survival according to the ANZSCTS database. As promising procedure for pathologies that impair the aortic root integrity, they can be adopted more widely, especially in Australian and New Zealand centres with experienced aortic units. Future studies are planned to assess freedom from valve deterioration and repeat surgery.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia. Electronic address: vikrantdhurandhar@hotmail.com.
authors.forename: Vikrant
authors.initials: V
authors.lastname: Dhurandhar
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Roneil
authors.initials: R
authors.lastname: Parikh
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Akshat
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Vallely
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Wilson
authors.affiliation: Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Deborah Ann
authors.initials: DA
authors.lastname: Black
authors.affiliation: CCRE Therapeutics, DEPM, Monash University, Melbourne, Vic., Australia.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Tran
authors.affiliation: CCRE Therapeutics, DEPM, Monash University, Melbourne, Vic., Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Reid
authors.affiliation: Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute, Sydney, NSW, Australia; Institute of Academic Surgery, The University of Sydney, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality* / Q000601:surgery*; D001021:Aortic Valve; D001315:Australia / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology
keywords: David procedure; Morbidity; Mortality; Outcomes; Survival; Valve sparing aortic root reconstruction; Valve sparing surgery; Yacoub procedure