title: Evidence-based Surgery of Aortic Regurgitation: Results of a Questionnaire in German-speaking Countries.
abstract: evidence-based medicine (EBM) approaches have reached broad acceptance, both in conservative and surgical disciplines. The aim of this study is to clarify the role of EBM in a rare condition of aortic regurgitation (AR) with surgical indication.
  
  
  
  A purpose-built Internet-based questionnaire was sent to 607 cardiovascular surgeons in Germany, Austria, and Switzerland. A virtual 64-year-old patient's medical history was presented, including two ultrasound images and one computed tomography scan, showing a 58-mm aortic root aneurysm and a severe trileaflet regurgitant aortic valve. Participants had to choose their preferred therapeutic strategy from a list. Additionally, demographics including nationality, the center size, and the frequency of similar types of patients referred to their departments were collected.
  
  
  
  Of 607 questionnaires, 100 were returned (16%). One participant was excluded due to conflicting answers. Most surgeons (n= 84; 84%) chose a valve-sparing root replacement (VSRR). A Bentall procedure was preferred by 13 surgeons (13%). Two surgeons voted for aortic valve replacement combined with partial root resection. The decision-making process was not significantly influenced by center size, nationality, or frequency of patients.
  
  
  
  Applying the current guidelines to our virtual study patient, 84% of participants acted accordingly choosing VSRR. Remarkably, 14% of these surgeons see less than 10 and 43% see not more than 20 comparable patients per year. Since the guidelines reserve VSRR for competent centers, those numbers as well as the guidelines themselves should be further discussed.
authors.affiliation: Department of Cardiac Surgery, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Dinges
authors.affiliation: Department of Cardiac Surgery, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria.
authors.forename: Johannes
authors.initials: J
authors.lastname: Steindl
authors.affiliation: Research Office (Biostatistics), Paracelsus Medical University, Salzburg, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hitzl
authors.affiliation: Department of Internal Medicine I, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria.|Institute of Physiology and Pathophysiology, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Tobias
authors.initials: T
authors.lastname: Kiesslich
authors.affiliation: Department of Cardiac Surgery, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria.
authors.forename: Rainald
authors.initials: R
authors.lastname: Seitelberger
mesh_terms: D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000639:trends; D019917:Blood Vessel Prosthesis Implantation / Q000639:trends*; D000066491:Clinical Decision-Making; D000072226:Computed Tomography Angiography / Q000639:trends; D018618:Echocardiography, Doppler, Color / Q000639:trends; D005060:Europe; D019317:Evidence-Based Medicine / Q000639:trends*; D019538:Health Care Surveys; D019918:Heart Valve Prosthesis Implantation / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000639:trends*; D066231:Surgeons / Q000639:trends*; D016896:Treatment Outcome; D016526:Workload