{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:28:19Z","timestamp":1791390499691,"version":"4.3.3"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2024,5,7]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">This study was performed to determine cusp causes of aortic regurgitation in patients with tricuspid aortic valves without significant aortic dilatation and define cusp pathologies amenable to surgical repair (aortic valve repair [AVr]) versus aortic valve replacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We retrospectively reviewed surgical reports of consecutive adults with tricuspid aortic valves undergoing surgery for clinically significant aortic regurgitation within a prospective registry from January 2005 to September 2019. Valvular mechanisms were determined by systematic in\u00a0vivo intraoperative quantification methods. Of 516 patients, 287 (56%) underwent repair (AVr; mean\u00b1SD age, 59.9\u00b112.4\u2009years; 81% men) and 229 (44%) underwent replacement (aortic valve replacement; mean\u00b1SD age, 62.8\u00b113.8\u2009years [\n                      <jats:italic>P<\/jats:italic>\n                      =0.01 compared to AVr]; 67% men). A single valvular mechanism was present in 454 patients (88%), with cusp prolapse (46%), retraction (24%), and perforation (18%) being the most common. Prolapse involved the right cusp in 86% of cases and was more frequent in men (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Two\u2010dimensional transesophageal echocardiography accuracy for predicting mechanisms was 73% to 82% for the right cusp, 55% to 61% for the noncoronary cusp, and 0% for the left\u2010coronary cusp. Cusp prolapse, younger age, and larger patient size were associated with successful AVr (all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.03), whereas retraction, perforation, older age, and concomitant mitral repair were associated with aortic valve replacement (all\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.03).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Right cusp prolapse is the most frequent single valvular mechanism in patients with tricuspid aortic valve aortic regurgitation, followed by cusp retraction and perforation. The accuracy of 2\u2010dimensional transesophageal echocardiography is limited for left and noncoronary cusp mechanistic assessment. Prolapse is associated with successful AVr, whereas retraction and perforation are associated with aortic valve replacement. With systematic intraoperative quantification methods and current surgical techniques, more than half of tricuspid aortic valve aortic regurgitation cases may be successfully repaired.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.123.032532","type":"journal-article","created":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T07:27:40Z","timestamp":1714462060000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Contemporary Valvular Mechanisms of Aortic Regurgitation in Tricuspid Aortic Valves: Importance in Repair Versus Replacement Strategy"],"prefix":"10.1161","volume":"13","author":[{"given":"Saifalislam","family":"Almaghrabi","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery Saarland University Medical Center and Saarland University Homburg\/Saar 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