{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T08:05:53Z","timestamp":1791705953599,"version":"4.3.4"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2018,4,10]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Surgical aortic root enlargement (ARE) during aortic valve replacement (AVR) allows for larger prosthesis implantation and may be an important adjunct to surgical AVR in the transcatheter valve-in-valve era. The incremental operative risk of adding ARE to AVR has not been established. We aimed to evaluate the early outcomes of patients undergoing AVR with or without ARE.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>From January 1990 to August 2014, 7039 patients underwent AVR (AVR+ARE, n=1854; AVR, n=5185) at a single institution. Patients with aortic dissection and active endocarditis were excluded. Mean age was 65\u00b114 years and 63% were male. Logistic regression and propensity score matching were used to adjust for unbalanced variables in group comparisons.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              Patients undergoing AVR+ARE were more likely to be female (46% versus 34%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) and had higher rates of previous cardiac surgery (18% versus 12%,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), chronic obstructive pulmonary disease (5% versus 3%,\n              <jats:italic>P<\/jats:italic>\n              =0.004), urgent\/emergent status (6% versus 4%,\n              <jats:italic>P<\/jats:italic>\n              =0.01), and worse New York Heart Association status (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). Most patients received bioprosthetic valves (AVR+ARE: 73.4% versus AVR: 73.3%,\n              <jats:italic>P<\/jats:italic>\n              =0.98) and also underwent concomitant cardiac procedures (AVR+ARE: 68% versus AVR: 67%,\n              <jats:italic>P<\/jats:italic>\n              =0.31). Mean prosthesis size implanted was slightly smaller in patients requiring AVR+ARE versus AVR (23.4\u00b12.1 versus 24.1\u00b12.3,\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001). In-hospital mortality was higher after AVR+ARE (4.3% versus 3.0%,\n              <jats:italic>P<\/jats:italic>\n              =0.008), although when the cohort was restricted to patients undergoing isolated aortic valve replacement with or without root enlargement, mortality was not statistically different (AVR+ARE: 1.7% versus AVR: 1.1%,\n              <jats:italic>P<\/jats:italic>\n              =0.29). After adjustment for baseline characteristics, AVR+ARE was not associated with an increased risk of in-hospital mortality when compared with AVR (odds ratio, 1.03; 95% confidence interval, 0.75\u20131.41;\n              <jats:italic>P<\/jats:italic>\n              =0.85). Furthermore, AVR+ARE was not associated with an increased risk of postoperative adverse events. Results were similar if propensity matching was used instead of multivariable adjustments for baseline characteristics.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>In the largest analysis to date, ARE was not associated with increased risk of mortality or adverse events. Surgical ARE is a safe adjunct to AVR in the modern era.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.117.030525","type":"journal-article","created":{"date-parts":[[2017,11,22]],"date-time":"2017-11-22T10:30:08Z","timestamp":1511346608000},"page":"1585-1594","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":76,"title":["Surgical Enlargement of the Aortic Root Does Not Increase the Operative Risk of Aortic Valve Replacement"],"prefix":"10.1161","volume":"137","author":[{"given":"Rodolfo V.","family":"Rocha","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cedric","family":"Manlhiot","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M.","family":"Feindel","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrence M.","family":"Yau","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigitte","family":"Mueller","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tirone E.","family":"David","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maral","family":"Ouzounian","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2008.08.015"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2011.04.048"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.736819"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.7246"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.104505"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.02.057"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs003"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(00)00859-7"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.901272"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.001180"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2004.04.042"},{"key":"e_1_3_3_13_2","first-page":"379","article-title":"The effect of prosthesis-patient mismatch on aortic bioprosthetic valve hemodynamic performance and patient clinical status.","volume":"12","author":"Pibarot P","year":"1996","unstructured":"Pibarot P, Honos GN, Durand LG, Dumesnil JG. 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