title: The Aortic Root: Natural History After Root-Sparing Ascending Replacement in Nonsyndromic Aneurysmal Patients.
abstract: BACKGROUND
  Leaving native aortic tissue in situ in root-sparing ascending aortic replacement raises concern regarding potential later need for root reoperation or for the potential occurrence of localized dissections or rupture in the residual root. The purpose of this study was to evaluate the natural growth of the aortic root after root-sparing aortic replacement.
  
  
  METHODS
  In all, 102 consecutive patients (mean age 61.8 ± 12.5 years; 60% male) who had undergone root-sparing aortic replacement had sufficient retrievable information regarding their aortic root diameter at postoperative baseline and follow-up imaging by computed tomography or echocardiography. The annual growth rate was evaluated and also compared according to the influence of valve morphology and concomitant aortic valve replacement. Furthermore, the years of natural history that would require for root enlargement to meet a 50 mm threshold of the root diameter were calculated.
  
  
  RESULTS
  The estimated growth rate of the aortic root after root-sparing aortic replacement is between 0.27 and 0.51 mm per year (mean 0.41 mm, varying according to the underlying diameter) and therefore fivefold less than other aortic regions. Accordingly, a root aneurysm indicating reoperation would not be expected for 29.1 years on average. Only patients with a diameter of 45 mm or more are at risk for reoperation, and not until at least after 10.4 years have passed. Neither the valve morphology (p = 0.62) nor concomitant aortic valve replacement (p = 0.86) influenced rate of root dilation.
  
  
  CONCLUSIONS
  In nonsyndromic patients, the aortic root is the slowest growing portion of the thoracic aorta. Leaving the native root, as in root-sparing ascending aortic replacement, is a safe approach regarding secondary root intervention for aortic root diameters of 45 mm or less.
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilian University, Munich, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Peterss
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Rohan
authors.initials: R
authors.lastname: Bhandari
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Departments of Economics and Preventive Medicine, Stony Brook University, Stony Brook, New York.
authors.forename: John A
authors.initials: JA
authors.lastname: Rizzo
authors.affiliation: China Center for Health Development Studies, Peking University, Beijing, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Fang
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Kuzmik
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Surgical Diseases 2, Kazan State Medical University, Kazan, Russia.
authors.forename: Bulat A
authors.initials: BA
authors.lastname: Ziganshin
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut. Electronic address: john.elefteriades@yale.edu.
authors.forename: John A
authors.initials: JA
authors.lastname: Elefteriades
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged