Mid-Term Results of Valve-Sparing Aortic Root Replacement in XXXX With Expanded Indications.

@entity1 @entity3665 @entity384 @entity337 @entity1580
BACKGROUND: The mid-term results of valve-sparing aortic root reimplantation (VSRR) for various indications were investigated. METHODS: From 2000 to 2013, 183 consecutive @entity1 undergoing VSRR were enrolled. Expanded indications, defined as a @entity1 on the marginal operative indication, included age 65 years or older (n  = 33), age 15 years or younger (n  = 4), acute @entity1580 (AAAD) (n  = 21), @entity3665 (n  = 8), reoperative root replacement (n  = 11), cusp prolapse (n  = 67), large aortoventricular junction of greater than 28 mm (AVJ) (n  = 42), preoperative severe @entity337 ( @entity337 ) (n  = 89), left ventricular ejection fraction 0.40 or less (n  = 12), @entity384 (n  = 66), New York Heart Association class III or greater (n  = 5), need for total arch replacement (n  = 29), and concomitant mitral valve repair (n  = 12). RESULTS: The overall survival at 5 years was 96.6%. Freedom from greater than mild @entity337 and reoperation at 5 years was 85.8% and 92.9%, respectively. Cox proportional hazard model revealed that AAAD, cusp prolapse, AVJ 28 mm or greater, and operation before 2009 were at risk for late @entity337 recurrence (p  = 0.015, p  = 0.0041, p  = 0.032, and p  = 0.014, respectively). After 2009, freedom from late @entity337 in the cusp prolapse group improved (p  = 0.055, versus control). Both freedom from recurrent @entity337 and reoperation were worse as the number of expanded indications increased (log-rank trend p = 0.00017 and p  = 0.00067, respectively). CONCLUSIONS: Surgical outcomes of VSRR in these @entity1 cohorts were satisfactory with some room for improvement in @entity1 with cusp prolapse. Although the indications for VSRR are being expanded, a larger number of expanded indications were associated with poor outcomes in terms of longevity of valve function.
