{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T22:53:29Z","timestamp":1785884009642,"version":"3.56.0"},"reference-count":22,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Different techniques allow implantation of biological aortic valve prostheses larger than associated with classic annulus sizing. We described a replica-based technique (upsizing) before that utilizes the patient's root anatomy. We here evaluate the safety and efficacy of upsizing compared with standard sizing using the Epic Supra bioprosthesis.<\/jats:p>\n                  <jats:p>We assessed 958 patients undergoing aortic valve replacement with the Epic Supra bioprosthesis between 2010 and 2023. Upsizing was defined as implantation of a prosthesis larger than the measured annular size without enlarging the annulus. We assessed hemodynamic and standard outcome parameters. Mean follow-up was 44.5\u2009\u00b1\u200931.2 months. Propensity score matching was used to adjust for baseline differences.<\/jats:p>\n                  <jats:p>Patient anatomy allowed upsizing in 62% of patients. Demographics and outcomes (perioperative mortality, reoperation, bleeding, and pacemaker implantation) were comparable between the matched groups. Immediate postoperative and long-term pressure gradients were consistently and significantly lower in the upsizing groups across all annular sizes (upsizing vs. control: 23\u2009mm; 12.9\u2009\u00b1\u20098.2 vs. 14.0\u2009\u00b1\u20095.6\u2009mm Hg, p\u2009=\u20090.029; 25\u2009mm; 10.8\u2009\u00b1\u20094.0 vs. 13.0\u2009\u00b1\u20094.4\u2009mm Hg, p\u2009&lt;\u20090.001; 27\u2009mm; 10.8\u2009\u00b1\u20094.0 vs. 13.0\u2009\u00b1\u20094.4\u2009mm Hg, p\u2009&lt;\u20090.001). Differences persisted at long-term follow-up but were less pronounced for the 25-mm annular size and greatest in the 27-mm group (8.5\u2009\u00b1\u20094.5 vs. 12.5\u2009\u00b1\u20095.5\u2009mm Hg; p\u2009&lt;\u20090.001). Long-term survival was numerically higher in the upsizing groups with statistical significance in annular size 25\u2009mm.<\/jats:p>\n                  <jats:p>Implanting a larger Epic Supra prosthesis than classically recommended (\u201cupsizing\u201d) is safe and associated with improved immediate- and long-term hemodynamics without increasing pacemaker, perioperative, or long-term mortality risks.<\/jats:p>","DOI":"10.1055\/a-2695-2575","type":"journal-article","created":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T22:52:31Z","timestamp":1759531951000},"page":"362-368","source":"Crossref","is-referenced-by-count":0,"title":["Long-Term Outcomes of Replica-Based Upsizing for Epic Supra Aortic Bioprosthesis"],"prefix":"10.1055","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5886-3472","authenticated-orcid":false,"given":"Hristo","family":"Kirov","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murat","family":"Mukharyamov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelique","family":"Runkel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tulio","family":"Caldonazo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torsten","family":"Doenst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,10,3]]},"reference":[{"issue":"14","key":"ref1","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1161\/CIRCULATIONAHA.119.041080","article-title":"Contemporary presentation and management of valvular heart disease: the EURObservational Research Programme Valvular Heart Disease II Survey","volume":"140","author":"B Iung","year":"2019","journal-title":"Circulation"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1016\/0002-9149(62)90047-4","article-title":"Aortic valve replacement with a caged ball valve","volume":"9","author":"D E Harken","year":"1962","journal-title":"Am J Cardiol"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jtcvs.2008.08.015","article-title":"Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database","volume":"137","author":"J M Brown","year":"2009","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"08","key":"ref4","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1111\/jocs.16607","article-title":"Treatment of valvular heart disease in young patients-\u201cearly evidence\u201d versus \u201clatest fashion\u201d","volume":"37","author":"H Kirov","year":"2022","journal-title":"J Card Surg"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1038\/nrcardio.2017.195","article-title":"Valvular disease: mechanical versus biological valve prostheses","volume":"15","author":"G B Lim","year":"2018","journal-title":"Nat Rev Cardiol"},{"issue":"05","key":"ref6","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/j.jtcvs.2011.05.007","article-title":"Where is the common sense in aortic valve replacement? A review of hemodynamics and sizing of stented tissue valves","volume":"142","author":"T Doenst","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"04","key":"ref7","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1093\/icvts\/ivx234","article-title":"Replica sizing strategy for aortic valve replacement improves haemodynamic outcome of the epic supra valve","volume":"25","author":"D Gonzalez-Lopez","year":"2017","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1111\/jocs.14412","article-title":"Minimally-invasive parasternal aortic valve replacement-a slow learning curve towards improved outcomes","volume":"35","author":"S Tkebuchava","year":"2020","journal-title":"J Card Surg"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1161\/CIRCULATIONAHA.105.587022","article-title":"Impact of prosthesis-patient mismatch on cardiac events and midterm mortality after aortic valve replacement in patients with pure aortic stenosis","volume":"113","author":"G Tasca","year":"2006","journal-title":"Circulation"},{"issue":"03","key":"ref10","doi-asserted-by":"crossref","first-page":"161","DOI":"10.5090\/kjtcs.2018.51.3.161","article-title":"The prognostic significance of patient-prosthesis mismatch after aortic valve replacement","volume":"51","author":"P Nardi","year":"2018","journal-title":"Korean J Thorac Cardiovasc Surg"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"244","DOI":"10.21037\/acs-2024-aae-25","article-title":"Aortic root anatomy: insights into annular and root enlargement techniques","volume":"13","author":"J Jahanyar","year":"2024","journal-title":"Ann Cardiothorac Surg"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1253\/circj.CJ-22-0718","article-title":"Association of valve size and hemodynamic performance with clinical outcomes in aortic valve replacement. A long-term follow-up in an Asian population","volume":"88","author":"Y Yen","year":"2024","journal-title":"Circ J"},{"key":"ref13","first-page":"159","article-title":"Bioprosthetic valve size selection to optimize aortic valve replacement surgical outcome: a fluid-structure interaction modeling study. CMES","volume":"127","author":"C Li","year":"2020","journal-title":"Comput Model Eng Sci"},{"issue":"01","key":"ref14","first-page":"107","article-title":"Manufacturer-provided effective orifice area index charts and the prevention of prosthesis-patient mismatch","volume":"21","author":"C M House","year":"2012","journal-title":"J Heart Valve Dis"},{"issue":"07","key":"ref15","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1055\/s-0038-1676814","article-title":"Limitations in the assessment of prosthesis-patient mismatch","volume":"68","author":"P A Amorim","year":"2020","journal-title":"Thorac Cardiovasc Surg"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jcin.2017.08.039","article-title":"Impact of pre-existing prosthesis-patient mismatch on survival following aortic valve-in-valve procedures","volume":"11","author":"P Pibarot","year":"2018","journal-title":"JACC Cardiovasc Interv"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.amjcard.2023.11.054","article-title":"Long-term outcomes of valve-in-valve transcatheter aortic valve implantation versus redo surgical aortic valve replacement: meta-analysis of Kaplan-Meier-derived data","volume":"212","author":"M P S\u00e1","year":"2024","journal-title":"Am J Cardiol"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"275","DOI":"10.21037\/acs-2024-aae-26","article-title":"Implanted size and structural valve deterioration in the Edwards Magna bioprosthesis","volume":"13","author":"D R Johnston","year":"2024","journal-title":"Ann Cardiothorac Surg"},{"issue":"05","key":"ref19","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1055\/a-2548-4098","article-title":"Cardiac surgery 2024 reviewed","volume":"73","author":"H Kirov","year":"2025","journal-title":"Thorac Cardiovasc Surg"},{"issue":"15","key":"ref21","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1161\/CIRCULATIONAHA.117.030525","article-title":"Surgical enlargement of the aortic root does not increase the operative risk of aortic valve replacement","volume":"137","author":"R V Rocha","year":"2018","journal-title":"Circulation"},{"issue":"02","key":"ref22","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.athoracsur.2023.02.044","article-title":"Aortic valve replacement vs aortic valve replacement + annular enlargement: apples to oranges?","volume":"117","author":"B Yang","year":"2024","journal-title":"Ann Thorac Surg"},{"issue":"07","key":"ref23","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1055\/a-2263-1933","article-title":"Impact of age on the relationship between cross-clamp time and mortality in cardiac surgery","volume":"72","author":"M Mukharyamov","year":"2024","journal-title":"Thorac Cardiovasc Surg"}],"container-title":["The Thoracic and Cardiovascular Surgeon"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2695-2575.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T22:37:38Z","timestamp":1785883058000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2695-2575"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,3]]},"references-count":22,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2026,8,4]]},"published-print":{"date-parts":[[2026,8]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2695-2575","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0171-6425","1439-1902"],"issn-type":[{"value":"0171-6425","type":"print"},{"value":"1439-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,3]]}}}