{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:50:02Z","timestamp":1753876202014,"version":"3.41.2"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T00:00:00Z","timestamp":1746144000000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Aortic regurgitation (AR) arises from leaflet disease and\/or dilatation of the functional aortic annulus complex. Understanding the mechanisms of AR informs surgical planning of valve and aorta repair. This study investigates the mechanisms, aetiologies, and outcomes of isolated native severe AR in a consecutive cohort of patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Patients with moderate-to-severe (3+)\/severe (4+) native valve AR, identified from our institutional echocardiography database (2014\u20132018), were included. Exclusions were significant concomitant valve disease, endocarditis, or aortic dissection. AR was classified per the El-Khoury system: Type I (normal leaflet motion: Ia\u2013ascending aorta\/sinotubular junction dilatation, Ib\u2013aortic root dilation, Ic\u2013aortic annular dilation), Type II (leaflet prolapse), and Type III (leaflet restriction). Valve anatomy and clinical outcomes, including mortality and surgical intervention, were analyzed. Of 282 patients (77.3% male), 58.5% had multiple AR mechanisms. Type II (leaflet prolapse) was most common (48.6%), followed by Type III (36.2%). Bicuspid aortic valve (BAV) represented 35.5% of the population, with leaflet prolapse observed in 72%. Multiple mechanisms were more frequent in BAV (77% vs. 48%, P &amp;lt; 0.001). After a median follow-up of 4.7 years (available for 97.5% of patients), 158 (57.5%) underwent an intervention with 48.7% having an aortic valve repair or valve-sparing aortic root replacement.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Although leaflet prolapse (Type II) was the pre-dominant AR mechanism, multiple contributing mechanisms were often present, particularly in BAV patients. Aortic valve repair accounted for nearly half of surgical interventions, underscoring the importance of mechanism identification to optimize repair and avoid valve replacement.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjopen\/oeaf042","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T07:45:10Z","timestamp":1746171910000},"source":"Crossref","is-referenced-by-count":0,"title":["Mechanistic classification of isolated severe aortic regurgitation in a contemporary cohort of patients"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4093-6340","authenticated-orcid":false,"given":"Rudy R","family":"Unni","sequence":"first","affiliation":[{"name":"Division of Cardiology, University of Ottawa Heart Institute , Room H-3407A, 40 Ruskin Street, Ottawa, ON , \u00a0 K1Y 4W7","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2815-8697","authenticated-orcid":false,"given":"Munir","family":"Boodhwani","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, University of Ottawa Heart Institute , 40 Ruskin Street, Ottawa, ON , \u00a0 K1Y 4W7","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim","family":"Jelaidan","sequence":"additional","affiliation":[{"name":"Adult Cardiology Department, King Faisal Cardiac Center, Ministry of National Guard Health Affairs , P.O. Box 9515, Jeddah 21423 ,","place":["Saudi Arabia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David T","family":"Harnett","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Memorial University , 300 Prince Philip Drive, St. John\u2019s, NL , \u00a0 A1B 3V6","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samia","family":"Massalha","sequence":"additional","affiliation":[{"name":"Rambam Health Care Centre , 8 HaAliyah HaShniya Street, Bat Galim, Haifa 3109601 ,","place":["Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Calvin","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Ottawa , 501 Smythe Road, Ottawa, ON , \u00a0 K1H 8L6","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Graeme","family":"Prosperi-Porta","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Ottawa Heart Institute , Room H-3407A, 40 Ruskin Street, Ottawa, ON , \u00a0 K1Y 4W7","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9348-0298","authenticated-orcid":false,"given":"David","family":"Glineur","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, University of Ottawa Heart Institute , 40 Ruskin Street, Ottawa, ON , \u00a0 K1Y 4W7","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian G","family":"Burwash","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Ottawa Heart Institute , Room H-3407A, 40 Ruskin Street, Ottawa, ON , \u00a0 K1Y 4W7","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kwan-Leung","family":"Chan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Ottawa Heart Institute , Room H-3407A, 40 Ruskin Street, Ottawa, ON , \u00a0 K1Y 4W7","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thais","family":"Coutinho","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , 200 1st St SW, Rochester, MN 55905 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angel","family":"Fu","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Ottawa Heart Institute , Room H-3407A, 40 Ruskin Street, Ottawa, ON , \u00a0 K1Y 4W7","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadav","family":"Willner","sequence":"additional","affiliation":[{"name":"Rambam Health Care Centre , 8 HaAliyah HaShniya Street, Bat Galim, Haifa 3109601 ,","place":["Israel"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6278-5670","authenticated-orcid":false,"given":"David","family":"Messika-Zeitoun","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Ottawa Heart Institute , Room H-3407A, 40 Ruskin Street, Ottawa, ON , \u00a0 K1Y 4W7","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luc","family":"Beauchesne","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Ottawa Heart Institute , Room H-3407A, 40 Ruskin Street, Ottawa, ON , \u00a0 K1Y 4W7","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,5,2]]},"reference":[{"key":"2025062619191170600_oeaf042-B1","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1097\/01.hco.0000153951.31887.a6","article-title":"Functional classification of aortic root\/valve 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Surg"},{"key":"2025062619191170600_oeaf042-B4","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.1016\/j.mayocp.2018.11.034","article-title":"Contemporary etiologies, mechanisms, and surgical approaches in pure native aortic regurgitation","volume":"94","author":"Yang","year":"2019","journal-title":"Mayo Clin Proc"},{"key":"2025062619191170600_oeaf042-B5","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.echo.2017.01.007","article-title":"Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance","volume":"30","author":"Zoghbi","year":"2017","journal-title":"J Am Soc Echocardiogr"},{"key":"2025062619191170600_oeaf042-B6","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.echo.2014.11.015","article-title":"Multimodality imaging of diseases of the thoracic aorta in adults: from the American society of echocardiography and the European association of cardiovascular imaging: endorsed by the society of cardiovascular computed tomography and society for cardiovascular magnetic resonance","volume":"28","author":"Goldstein","year":"2015","journal-title":"J Am Soc Echocardiogr"}],"container-title":["European Heart Journal 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