Residual and Progressive XXXX After  Valve-Sparing Root Replacement: A Propensity-Matched Multi-Institutional Analysis in 764 @entity1 .

@entity1 @entity1984 @entity886 @entity63546 @entity337 @entity439
BACKGROUND: Residual/progressive @entity337 (rAR, @entity63546 ) after valve-sparing aortic root replacement (V-SARR) can lead to reoperations. We sought to characterize risk factors of mild rAR and @entity63546 after V-SARR in a multicenter cohort. The effect of additional cusp repair on valve function was analyzed using propensity matching. METHODS: A total of 1,015 @entity1 after V-SARR were identified with (n  = 288, 28%) or without additional cusp/commissure repair (n  = 727, 72%) at four cardiac units in Germany. A total of 764 @entity1 fulfilling transthoracic echocardiography follow-up-criteria comprised the study cohort. Logistic regression was used for risk factor analysis with endpoints rAR, new onset @entity1984 , and @entity63546 . t tests and analyses of variance were used for between-group differences. The effects of additional cusp repair on valve function were studied comparing propensity-matched quintiles. RESULTS: The incidence of rAR was 29%, with influencing factors @entity439 size (p  = 0.07) and preoperative @entity886 (p  = 0.08). It was found more often among nonsyndromic @entity1 (34% vs. 14%; OR, 0.4; p < 0.001). Progression of rAR was detectable in 30% after a mean of 4.3 years. The progression rate of rAR    0.3 grades per @entity1 -year within the first 5 years. When quintiles identified by propensity score were compared, additional cusp repair was linked to new onset @entity1984 (p  = 0.016) while it was not linked to rAR (p  = 0.14) or @entity63546 (p  = 0.5). CONCLUSIONS: The incidences of rAR and @entity63546 are considerable after V-SARR. @entity1 should be operated on before large @entity439 are present. New onset @entity1984 after an initially good functional result is more likely after an additional cusp repair, while rAR and @entity63546 are not influenced by cusp repair.
