{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T13:55:40Z","timestamp":1775829340321,"version":"3.50.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T00:00:00Z","timestamp":1580688000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["5T32HL069749"],"award-info":[{"award-number":["5T32HL069749"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["FT32CA093245"],"award-info":[{"award-number":["FT32CA093245"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p\/><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>Aortic insufficiency (AI) is common in patients with proximal aortic disease, but limited options exist to facilitate aortic valve repair (AVr) in this population. This study reports \u2018real-world\u2019 early results of AVr using newly FDA-approved trileaflet and bicuspid geometric annuloplasty rings for patients with AI undergoing proximal aortic repair (PAR) in a single referral centre.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>All patients undergoing AVr with a rigid internal geometric annuloplasty ring (n\u2009=\u200947) in conjunction with PAR (ascending +\/\u2212 root +\/\u2212 arch) were included. Thirty-six patients underwent AVr with a trileaflet ring, and 11 patients underwent AVr with a bicuspid ring. The rings were implanted in the subannular position, and concomitant leaflet repair was performed if required for cusp prolapse identified after ring placement.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The median age was 58\u2009years [interquartile range (IQR) 46\u201370]. PAR included supracoronary ascending replacement in 26 (55%) patients and remodelling valve-sparing root replacement with selective sinus replacement in 20 (42%) patients. Arch replacement was performed in 38 (81%) patients, including hemi-arch in 34 patients and total arch in 4 patients. There was no 30-day\/in-hospital mortality. Preoperative AI was 3\u20134+ in 37 (79%) patients. Forty-one (87%) patients had zero\u2013trace AI on post-repair transoesophageal echocardiography, and 6 patients had 1+ AI. The median early post-repair mean gradient was 13\u2009mmHg (IQR 5\u201320). Follow-up imaging was available in 32 (68%) patients at a median of 11\u2009months (IQR 10\u201313) postsurgery. AI was \u22641+ in 97% of patients with 2+ AI in 1 patient. All patients were alive and free from aortic valve reintervention at last follow-up.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Early results with geometric rigid internal ring annuloplasty for AVr in patients undergoing PAR appear promising and allow a standardized approach to repair with annular diameter reduction and cusp plication when needed. Longer-term follow-up will be required to ensure the durability of the procedure.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezaa009","type":"journal-article","created":{"date-parts":[[2020,1,3]],"date-time":"2020-01-03T20:19:07Z","timestamp":1578082747000},"page":"1137-1144","source":"Crossref","is-referenced-by-count":15,"title":["Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: early results from a single-centre experience"],"prefix":"10.1093","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4753-3897","authenticated-orcid":false,"given":"Oliver K","family":"Jawitz","sequence":"first","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vignesh","family":"Raman","sequence":"first","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jatin","family":"Anand","sequence":"first","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8906-3600","authenticated-orcid":false,"given":"Muath","family":"Bishawi","sequence":"first","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soraya L","family":"Voigt","sequence":"first","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3331-4810","authenticated-orcid":false,"given":"Julie","family":"Doberne","sequence":"first","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew M","family":"Vekstein","sequence":"first","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8442-6150","authenticated-orcid":false,"given":"E Hope","family":"Weissler","sequence":"first","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph W","family":"Turek","sequence":"first","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G Chad","family":"Hughes","sequence":"first","affiliation":[{"name":"Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,2,3]]},"reference":[{"key":"2020052015082426900_ezaa009-B1","doi-asserted-by":"crossref","first-page":"1152","DOI":"10.1016\/S0735-1097(00)00834-2","article-title":"Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the Veterans Affairs randomized trial","volume":"36","author":"Hammermeister","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"2020052015082426900_ezaa009-B2","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.jtcvs.2008.08.054","article-title":"Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes","volume":"137","author":"Boodhwani","year":"2009","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020052015082426900_ezaa009-B3","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/S0022-5223(20)31429-X","article-title":"Valvuloplasty for aortic insufficiency","volume":"102","author":"Cosgrove","year":"1991","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020052015082426900_ezaa009-B4","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.ejcts.2009.06.021","article-title":"Aortic valve repair leads to a low incidence of valve-related complications","volume":"37","author":"Aicher","year":"2010","journal-title":"Eur J Cardiothorac Surg"},{"key":"2020052015082426900_ezaa009-B5","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1016\/j.jtcvs.2011.01.039","article-title":"Technique for aortic valve annuloplasty using an intra-annular \u201chemispherical\u201d frame","volume":"142","author":"Rankin","year":"2011","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020052015082426900_ezaa009-B6","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1016\/j.athoracsur.2015.01.050","article-title":"A regulated trial of bicuspid aortic valve repair supported by geometric ring annuloplasty","volume":"99","author":"Mazzitelli","year":"2015","journal-title":"Ann Thorac Surg"},{"key":"2020052015082426900_ezaa009-B7","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1093\/ejcts\/ezt407","article-title":"Early results of a novel technique for ring-reinforced aortic valve and root restoration","volume":"45","author":"Mazzitelli","year":"2014","journal-title":"Eur J Cardiothorac Surg"},{"key":"2020052015082426900_ezaa009-B8","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.jtcvs.2013.08.031","article-title":"Hemodynamic outcomes of geometric ring annuloplasty for aortic valve repair: a 4-center pilot trial","volume":"148","author":"Mazzitelli","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020052015082426900_ezaa009-B9","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1093\/ejcts\/ezv234","article-title":"Geometric ring annuloplasty as an adjunct to aortic valve repair: clinical investigation of the HAART 300 device","volume":"49","author":"Mazzitelli","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"2020052015082426900_ezaa009-B10","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.athoracsur.2012.08.034","article-title":"Early results after implantation of a new geometric annuloplasty ring for aortic valve repair","volume":"95","author":"Mazzitelli","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2020052015082426900_ezaa009-B11","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1161\/CIRCULATIONAHA.106.622761","article-title":"Causes of pure aortic regurgitation in patients having isolated aortic valve replacement at a single US tertiary hospital (1993 to 2005)","volume":"114","author":"Roberts","year":"2006","journal-title":"Circulation"},{"key":"2020052015082426900_ezaa009-B12","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1097\/IMI.0000000000000539","article-title":"Geometric ring annuloplasty for aortic valve repair during aortic aneurysm surgery: two-year clinical trial results","volume":"13","author":"Rankin","year":"2018","journal-title":"Innovations"},{"key":"2020052015082426900_ezaa009-B13","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.jtcvs.2013.09.011","article-title":"Frailty and risk in proximal aortic surgery","volume":"147","author":"Ganapathi","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020052015082426900_ezaa009-B14","year":"2019"},{"key":"2020052015082426900_ezaa009-B15","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/j.athoracsur.2016.06.085","article-title":"Imaging surveillance after proximal aortic operations: is it necessary?","volume":"103","author":"Iribarne","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"2020052015082426900_ezaa009-B16","first-page":"387","article-title":"Individualized thoracic aortic replacement for the aortopathy of biscuspid aortic valve disease","volume":"20","author":"Lima","year":"2011","journal-title":"J Heart Valve Dis"},{"key":"2020052015082426900_ezaa009-B17","doi-asserted-by":"crossref","first-page":"2896","DOI":"10.1016\/j.jtcvs.2014.04.014","article-title":"Antegrade versus retrograde cerebral perfusion for hemiarch replacement with deep hypothermic circulatory arrest: does it matter? A propensity-matched analysis","volume":"148","author":"Ganapathi","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020052015082426900_ezaa009-B18","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1016\/j.jtcvs.2016.08.014","article-title":"Does moderate hypothermia really carry less bleeding risk than deep hypothermia for circulatory arrest? A propensity-matched comparison in hemiarch replacement","volume":"152","author":"Keenan","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020052015082426900_ezaa009-B19","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.athoracsur.2015.08.002","article-title":"Electroencephalography during hemiarch replacement with moderate hypothermic circulatory arrest","volume":"101","author":"Keenan","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"2020052015082426900_ezaa009-B20","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1016\/j.athoracsur.2018.04.044","article-title":"Outcomes of planned two-stage hybrid aortic repair with dacron-replaced proximal landing zone","volume":"106","author":"Ranney","year":"2018","journal-title":"Ann Thorac Surg"},{"key":"2020052015082426900_ezaa009-B21","first-page":"e523","article-title":"2008 Focused update incorporated into the ACC\/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons","volume":"118","author":"Bonow","year":"2008","journal-title":"Circulation"},{"key":"2020052015082426900_ezaa009-B22","doi-asserted-by":"crossref","first-page":"60","DOI":"10.21037\/jovs.2018.01.13","article-title":"Aortic valve insufficiency in aortic root aneurysms: consider every valve for repair","volume":"4","author":"Al-Atassi","year":"2018","journal-title":"J Vis Surg"},{"key":"2020052015082426900_ezaa009-B23","doi-asserted-by":"crossref","first-page":"1497.e15","DOI":"10.1016\/j.cjca.2015.05.016","article-title":"Is aortic valve repair reproducible? Analysis of the learning curve for aortic valve repair","volume":"31","author":"Malas","year":"2015","journal-title":"Can J Cardiol"},{"key":"2020052015082426900_ezaa009-B24","doi-asserted-by":"crossref","DOI":"10.1093\/ejcts\/ezz033","article-title":"Variability of repairable bicuspid aortic valve phenotypes: towards an anatomical and repair-oriented classification","author":"de Kerchove","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"2020052015082426900_ezaa009-B25","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.1016\/j.athoracsur.2014.06.052","article-title":"Leaflet reconstructive techniques for aortic valve repair","volume":"98","author":"Mazzitelli","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"2020052015082426900_ezaa009-B26","doi-asserted-by":"crossref","first-page":"S740","DOI":"10.1016\/j.athoracsur.2006.11.017","article-title":"Preservation of the bicuspid aortic valve","volume":"83","author":"Schafers","year":"2007","journal-title":"Ann Thorac Surg"},{"key":"2020052015082426900_ezaa009-B27","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jtcvs.2017.05.108","article-title":"Patient-tailored aortic root repair in adult marfanoid patients: surgical considerations and outcomes","volume":"155","author":"Urbanski","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2020052015082426900_ezaa009-B28","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.1016\/j.athoracsur.2013.12.022","article-title":"Late outcome of noncoronary sinus replacement in patients with bicuspid aortic valves and aortopathy","volume":"97","author":"Ugur","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"2020052015082426900_ezaa009-B29","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1016\/j.athoracsur.2006.09.021","article-title":"Coronary insufficiency after stentless aortic root replacement: risk factors and solutions","volume":"83","author":"Kincaid","year":"2007","journal-title":"Ann Thorac Surg"},{"key":"2020052015082426900_ezaa009-B30","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1016\/j.athoracsur.2019.04.071","article-title":"Percutaneous management of coronary button kinking after emergency aortic root replacement","volume":"109","author":"Patel","year":"2020","journal-title":"Ann Thorac Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/57\/6\/1137\/33242825\/ezaa009.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/57\/6\/1137\/33242825\/ezaa009.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,15]],"date-time":"2021-02-15T02:32:38Z","timestamp":1613356358000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/57\/6\/1137\/5721432"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2,3]]},"references-count":30,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,2,3]]},"published-print":{"date-parts":[[2020,6,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezaa009","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"value":"1010-7940","type":"print"},{"value":"1873-734X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,6]]},"published":{"date-parts":[[2020,2,3]]}}}