• Mario Gaudino, Christopher Lau, Monica Munjal, Dimitrios Avgerinos, and Leonard N Girardi.
• Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
• J. Thorac. Cardiovasc. Surg. 2015 Nov 1; 150 (5): 1120-9.e1.

ObjectiveThe study objective was to give an overview of the current state of the art of the surgical treatment of aortic root pathologies in a high-volume center.MethodsFrom May 1997 to January 2014, aortic root replacement was performed in 890 consecutive patients; 289 received a mechanical composite valved graft, 421 received a biologic composite valved graft, and 180 received a valve-sparing reconstruction. Propensity matching analysis was used to neutralize the differences in baseline characteristics between patients assigned to the different procedures.ResultsOperative mortality was 0.2% (0% in the valve-sparing reconstruction group); the incidence of major postoperative complications was less than 0.5%. Predictors of adverse in-hospital outcome were age, nonelective operation, renal status, reoperation, New York Heart Association class, ejection fraction, and concomitant procedures. Five-year survival was 89.4%. Previous myocardial infarction, preoperative renal status, redo operation, and concomitant procedures were significantly associated with follow-up death. In the propensity-matched groups, the type of operation performed did not affect in-hospital and late outcome. Aortic reintervention rates at 5 years were 0% for the mechanical composite valved graft group, 2.4% for the biologic composite valved graft group, and 7.3% for the valve-sparing reconstruction series.ConclusionsIn the current era, aortic root replacement can be performed with low perioperative risk in high-volume aortic centers. The type of operation performed does not affect early or late survival. Although the mechanical composite valved graft remains the gold standard for durability, the biologic composite valved graft and valve-sparing reconstruction are excellent options for those who cannot take or want to avoid long-term anticoagulation.Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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