{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T17:17:57Z","timestamp":1765041477108,"version":"3.41.2"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>There is an ongoing debate regarding whether patients benefit more from root replacement compared to a reconstruction of the sinuses of Valsalva in acute type A aortic dissection (aTAAD). In those with known or suspected connective tissue disorders, root replacement is considered appropriate. However, there are currently no diameter-based guidelines regarding the best approach in patients with minimally to moderately dilated root and no connective tissue disorders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>From January 2005 to December 2022, a two-centre registry of aTAAD was created. Patients were included based on their age (\u226460\u2009years), the absence of root entry and dilatation &amp;gt;50 mm and the absence of syndromic hereditable aortic disease. Patients were divided into 2 groups based on the proximal procedure, root reconstruction and root replacement. Propensity score pair matching was performed based on preoperative characteristics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Cumulative incidence of reintervention at 10\u2009years was slightly higher after root reconstruction 13% vs 3.9% in the matched group (P\u2009=\u20090.040). Survival at 10\u2009years was not affected by the procedure independently of the matching 72.1% vs 71.4% (P\u2009=\u20090.2). Uni- and multivariate Cox regressions showed that a root diameter of &amp;gt;40 mm was associated with a hazard ratio of 7.7 (95% confidence interval 2.6\u201323) and 5.4 (7\u201317), respectively, for reoperation for aneurysm and pseudoaneurysm.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Rate of reoperation due to proximal pseudoaneurysm and aneurysm could be significantly reduced with a lower threshold of 40\u2009mm to replace the aortic root in aTAAD than in elective cases.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezae024","type":"journal-article","created":{"date-parts":[[2024,1,21]],"date-time":"2024-01-21T01:14:24Z","timestamp":1705799664000},"source":"Crossref","is-referenced-by-count":1,"title":["The non to moderately dilated root in acute type A aortic dissection: outcomes of the PENN\u2013BERN registry in young, non-syndromic patients"],"prefix":"10.1093","volume":"65","author":[{"given":"Selim","family":"Mosbahi","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Surgery, University of Pennsylvania , Philadelphia, PA, USA"},{"name":"Department of Cardiac Surgery, University Hospital Bern, University of Bern , Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3305-9343","authenticated-orcid":false,"given":"Matthias","family":"Siepe","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Bern, University of Bern , Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nimesh D","family":"Desai","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5518-173X","authenticated-orcid":false,"given":"Fabio","family":"Pregaldini","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Bern, University of Bern , Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Nucera","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Bern, University of Bern , Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikolaj","family":"Berezowski","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9690-3137","authenticated-orcid":false,"given":"John J","family":"Kelly","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fei","family":"Jiang","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Zhao","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wilson Y","family":"Szeto","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian S","family":"Schoenhoff","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Bern, University of Bern , Bern, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph E","family":"Bavaria","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Surgery, University of Pennsylvania , Philadelphia, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,1,19]]},"reference":[{"key":"2024013022292954800_ezae024-B1","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.athoracsur.2018.12.043","article-title":"Operative and long-term outcomes after curative repair of acute dissection involving the proximal aorta","volume":"108","author":"Urbanski","year":"2019","journal-title":"Ann Thorac Surg"},{"key":"2024013022292954800_ezae024-B2","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/j.athoracsur.2022.06.041","article-title":"The aortic root in acute type A dissection: repair or replace?","volume":"115","author":"Arabkhani","year":"2023","journal-title":"Ann Thorac Surg"},{"key":"2024013022292954800_ezae024-B3","doi-asserted-by":"crossref","first-page":"e334","DOI":"10.1161\/CIR.0000000000001106","article-title":"2022 ACC\/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"146","author":"Isselbacher","year":"2022","journal-title":"Circulation"},{"key":"2024013022292954800_ezae024-B4","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/j.jtcvs.2020.04.061","article-title":"Commentary: surgery of acute type A aortic dissection: are we appropriately managing the aortic root?","volume":"163","author":"Bachet","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024013022292954800_ezae024-B5","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/j.jtcvs.2020.04.062","article-title":"Commentary: how aggressive should we be in replacing the aortic root during type A dissection?","volume":"163","author":"Dagenais","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024013022292954800_ezae024-B6","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur Heart J"},{"key":"2024013022292954800_ezae024-B7","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1093\/ejcts\/ezz145","article-title":"Standards of reporting in open and endovascular aortic surgery (STORAGE guidelines)","volume":"56","author":"Rylski","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024013022292954800_ezae024-B8","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1097\/00000658-200109000-00007","article-title":"New paradigms and improved results for the surgical treatment of acute type A dissection","volume":"234","author":"Bavaria","year":"2001","journal-title":"Ann Surg"},{"key":"2024013022292954800_ezae024-B9","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1111\/j.1538-7836.2005.01204.x","article-title":"Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients","volume":"3","author":"Schulman","year":"2005","journal-title":"J Thromb Haemost"},{"key":"2024013022292954800_ezae024-B10","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/j.jtcvs.2020.04.064","article-title":"Midterm outcomes and durability of sinus segment preservation compared with root replacement for acute type A aortic dissection","volume":"163","author":"Bojko","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024013022292954800_ezae024-B11","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1093\/ejcts\/ezw038","article-title":"Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis","volume":"50","author":"Castrovinci","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024013022292954800_ezae024-B12","first-page":"10","article-title":"Aniticoagulation in patients following prosthetic heart valve replacement","volume":"15","author":"Akhtar","year":"2009","journal-title":"Ann Thorac Cardiovasc Surg"},{"key":"2024013022292954800_ezae024-B13","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1002\/clc.22435","article-title":"The HAS-BLED score for predicting major bleeding risk in anticoagulated patients with atrial fibrillation: a systematic review and meta-analysis","volume":"38","author":"Zhu","year":"2015","journal-title":"Clin Cardiol"},{"key":"2024013022292954800_ezae024-B14","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1067\/mtc.2002.120330","article-title":"What operation for acute type A dissection?","volume":"123","author":"Elefteriades","year":"2002","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024013022292954800_ezae024-B15","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1093\/ejcts\/ezy266","article-title":"A systemic review and meta-analysis: Bentall versus David procedure in acute type A aortic dissection","volume":"55","author":"Mosbahi","year":"2019","journal-title":"Eur J Cardiothorac Surg"},{"key":"2024013022292954800_ezae024-B16","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.clinimag.2015.10.010","article-title":"Proximal thoracic aortic diameters: transesophageal-echocardiography- versus computed-tomography-derived measurements","volume":"40","author":"Agarwal","year":"2016","journal-title":"Clin Imaging"},{"key":"2024013022292954800_ezae024-B17","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/j.jacc.2013.12.028","article-title":"How does the ascending aorta geometry change when it dissects?","volume":"63","author":"Rylski","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2024013022292954800_ezae024-B18","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/j.athoracsur.2014.04.050","article-title":"Long-term results of neomedia sinus valsalva repair in 489 patients with type A aortic dissection","volume":"98","author":"Rylski","year":"2014","journal-title":"Ann Thorac Surg"},{"key":"2024013022292954800_ezae024-B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2022.12.002","article-title":"Aortic root repair in acute type A aortic dissection: neomedia or no neomedia","author":"Ahmad","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024013022292954800_ezae024-B20","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1016\/j.jtcvs.2017.11.089","article-title":"Short-term outcomes of a simple and effective approach to aortic root and arch repair in acute type A aortic dissection","volume":"155","author":"Yang","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024013022292954800_ezae024-B21","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1016\/j.athoracsur.2007.01.025","article-title":"Late complications of gelatin-resorcin-formalin glue in the repair of acute type A aortic dissection","volume":"83","author":"Hata","year":"2007","journal-title":"Ann Thorac Surg"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejcts\/advance-article-pdf\/doi\/10.1093\/ejcts\/ezae024\/56285022\/ezae024.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/65\/1\/ezae024\/56467030\/ezae024.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejcts\/article-pdf\/65\/1\/ezae024\/56467030\/ezae024.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T22:30:28Z","timestamp":1706653828000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/doi\/10.1093\/ejcts\/ezae024\/7582297"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,1]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezae024","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"type":"print","value":"1010-7940"},{"type":"electronic","value":"1873-734X"}],"subject":[],"published-other":{"date-parts":[[2024,1,1]]},"published":{"date-parts":[[2024,1,1]]},"article-number":"ezae024"}}