{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:28:25Z","timestamp":1791390505123,"version":"4.3.3"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T00:00:00Z","timestamp":1738368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100005970","name":"German Heart Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005970","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>To define morphologic risk constellations during valve-sparing aortic root replacement (VSARR) for aortic valves with paracommissural fenestrations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Patients from the multicentre prospective intention-to-treat VSARR-registry German Aortic Root Repair Registry (GEARR) were screened for paracommissural cusp fenestrations. We studied a combined end-point of residual aortic regurgitation (rAR) on post-cardiopulmonary bypass (CPB) transesophageal echocardiography (TEE), mid-term progress of rAR (transthoracic echocardiography) and aortic valve replacement for AR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Of a total of 762 registry patients (operated 2016\u20132024), 145 were identified with \u22651 paracommissural cusp fenestration. Eighteen patients (12%) were not treated as planned but underwent composite valved graft (CVG) implantation. Mean follow-up time was 3\u2009years. Upon post-CPB TEE, rAR grade 1 or 2 were present in 44 (33%) and 3 (2%) patients. 50% of patients with fenestrations in more than one cusp showed early progression of rAR. At 3 years, freedom from the combined end-point was 78% (99% CI 74\u201379%) for the complete study cohort. Patients with a maximum free margin length difference of &amp;lt;5 mm, reflecting balanced root anatomy with respect to sinus and cusp sizes, had a significantly better outcome than those with \u22655 mm: at 3 years, freedom from the combined end-point was 86% (99% CI 80\u201391%) vs 41% (99% CI 38\u201346%, P\u2009=\u20090.011). Outcome was worst for patients with cusp prolapse and a free margin length difference of &amp;gt;5 mm (30% vs 70%, P\u2009=\u20090.018).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Fenestrations in more than one cusp, inhomogeneities of cusp-free margin lengths, and additional prolapse are associated with inferior outcome after VSARR for valves with paracommissural fenestrations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical trial registration number<\/jats:title>\n                  <jats:p>DRKS00007872<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf034","type":"journal-article","created":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T07:03:36Z","timestamp":1738393416000},"source":"Crossref","is-referenced-by-count":2,"title":["Valve-sparing aortic root replacement for valves with paracommissural fenestrations: which valve will fail?"],"prefix":"10.1093","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0985-9650","authenticated-orcid":false,"given":"Fabian A","family":"Kari","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital , Munich,","place":["Germany"]},{"name":"German Heart Center Munich, Technical University of Munich , Munich,","place":["Germany"]},{"name":"Congenital and Pediatric Cardiac Surgery, European Children\u2019s Heart Center (EKHZ) , Munich,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Czerny","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart Center Freiburg , Freiburg,","place":["Germany"]},{"name":"Faculty of Medicine, University of Freiburg , Freiburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Borger","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Leipzig Heart Center , Leipzig,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7940-0629","authenticated-orcid":false,"given":"Martin","family":"Misfeld","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Leipzig Heart Center , Leipzig,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bartosz","family":"Rylski","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart Center Freiburg , Freiburg,","place":["Germany"]},{"name":"Faculty of Medicine, University of Freiburg , Freiburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Zimmer","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Inselspital Bern , Bern,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3305-9343","authenticated-orcid":false,"given":"Matthias","family":"Siepe","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Inselspital Bern , Bern,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Hagl","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital , Munich,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Detter","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart Center Hamburg , Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3415-3385","authenticated-orcid":false,"given":"Johannes","family":"Petersen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart Center Hamburg , Hamburg,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doreen","family":"Richardt","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Campus Luebeck , Luebeck,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9508-3261","authenticated-orcid":false,"given":"Stephan","family":"Ensminger","sequence":"additional","affiliation":[{"name":"Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Campus Luebeck , Luebeck,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0925-6160","authenticated-orcid":false,"given":"Paul","family":"Werner","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Medical University of Vienna , Vienna,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4950-5432","authenticated-orcid":false,"given":"Martin","family":"Andreas","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Medical University of Vienna , Vienna,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1880-152X","authenticated-orcid":false,"given":"Sven","family":"Peterss","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital , 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