• Fabian A Kari, Kai-Nicolas Doll, Wolfgang Hemmer, Markus Liebrich, Hans-Hinrich Sievers, Doreen Richardt, Hermann Reichenspurner, Christian Detter, Matthias Siepe, Martin Czerny, and Friedhelm Beyersdorf.
• Department of Cardiovascular Surgery, Heart Center Freiburg University, Freiburg, Germany. Electronic address: fabian.alexander.kari@universitaets-herzzentrum.de.
• Ann. Thorac. Surg. 2016 Apr 1; 101 (4): 1500-6.

BackgroundResidual/progressive aortic regurgitation (rAR, pAR) after valve-sparing aortic root replacement (V-SARR) can lead to reoperations. We sought to characterize risk factors of mild rAR and pAR after V-SARR in a multicenter cohort. The effect of additional cusp repair on valve function was analyzed using propensity matching.MethodsA total of 1,015 patients 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 patients fulfilling transthoracic echocardiography follow-up-criteria comprised the study cohort. Logistic regression was used for risk factor analysis with endpoints rAR, new onset AR, and pAR. 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.ResultsThe incidence of rAR was 29%, with influencing factors aneurysm size (p = 0.07) and preoperative aortic valve function (p = 0.08). It was found more often among nonsyndromic patients (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 patient-year within the first 5 years. When quintiles identified by propensity score were compared, additional cusp repair was linked to new onset AR (p = 0.016) while it was not linked to rAR (p = 0.14) or pAR (p = 0.5).ConclusionsThe incidences of rAR and pAR are considerable after V-SARR. Patients should be operated on before large aneurysms are present. New onset AR after an initially good functional result is more likely after an additional cusp repair, while rAR and pAR are not influenced by cusp repair.Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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