{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T16:54:22Z","timestamp":1762102462769,"version":"3.37.3"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,11,12]],"date-time":"2019-11-12T00:00:00Z","timestamp":1573516800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,11,12]],"date-time":"2019-11-12T00:00:00Z","timestamp":1573516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Cardiothorac Surg"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n              <jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Aortic valve sparing surgery (AVS), in combination with aortic cusp repair (ACR), still raises many questions about the increased surgical complexity and applicability for patients with pure aortic valve regurgitation (AR). The aim of this study was to investigate our long-term outcomes and predictors of recurrent AR (&gt;\u20092+) after AVS and reconstructive cusp surgery.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We reviewed data of 81 patients who underwent AVS (a reimplantation technique) with concomitant ACR for AR and or dilatation of the aortic root at our institution during the period from April 2004 to October 2016. On preoperative echocardiography, the majority of the patients, 70 (86.4%) presented with severe AR grade (&gt;\u20093+) and 28 (34.5%) of the patients had the bicuspid phenotype. Time to event analysis (long-term survival, freedom from reoperation, and recurrence of AR &gt;\u20092+) was performed with the Kaplan\u2013Meier method. Multivariate Cox regression risk analysis was performed to identify independent predictors of recurrent AR (&gt;\u20092+). The mean follow-up was 5.3\u2009\u00b1\u20093.3\u2009years and 100% complete.<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The in-hospital (30-day) mortality rate after elective surgery was 1.2%. The overall actuarial survival rates were 92.9\u2009\u00b1\u20093.1% and 90.4\u2009\u00b1\u20093.9% at five and 10\u2009years, respectively. Actuarial freedom from recurrent AR (&gt;\u20092+) was 83.7\u2009\u00b1\u20094.5% within the cohort at five and 10\u2009years. The cumulative freedom from all causes of cardiac reoperation was 94.2\u2009\u00b1\u20092.8% within the cohort at 10\u2009years. Neither bleeding nor thromboembolic or permanent neurologic events were reported during follow-up. By multivariate analysis, independent predictors of reccurent AR (&gt;\u20092+) were an effective height lower than 9\u2009mm (p= 0.02) and intraoperative residual mild AR (p= 0.0001).<\/jats:p>\n              <\/jats:sec>\n              <jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>AVS with ACR, combined in a systematic fashion, is a safe and reproducible option with low risk of long-term valve related events and normal life expectancy for patients with pure aortic regurgitation.<\/jats:p>\n                <jats:p>The competent aortic valve and effective height, not lower than 9\u2009mm intraoperatively, are mandatory to achieve long-lasting AV competency.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13019-019-1019-3","type":"journal-article","created":{"date-parts":[[2019,11,12]],"date-time":"2019-11-12T16:03:06Z","timestamp":1573574586000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Long-term outcomes and predictors of recurrent aortic regurgitation after aortic valve-sparing and reconstructive cusp surgery: a single centre experience"],"prefix":"10.1186","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2967-3471","authenticated-orcid":false,"given":"Dainius","family":"Karciauskas","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vaida","family":"Mizariene","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Povilas","family":"Jakuska","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Egle","family":"Ereminiene","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jolanta Justina","family":"Vaskelyte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irena","family":"Nedzelskiene","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarunas","family":"Kinduris","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rimantas","family":"Benetis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,11,12]]},"reference":[{"issue":"6","key":"1019_CR1","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1016\/j.ejcts.2009.12.031","volume":"37","author":"George Matalanis","year":"2010","unstructured":"Matalanis G, Shi WY, Hayward PAR. Correction of leaflet prolapse extends the spectrum of patients suitable for valve-sparing aortic root replacement. Eur J Cardio-Thoracic Surg [Internet]. 2010;37(6):1311\u20131316. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20138533.","journal-title":"European Journal of Cardio-Thoracic Surgery"},{"issue":"11_suppl_1","key":"1019_CR2","doi-asserted-by":"publisher","first-page":"S120","DOI":"10.1161\/CIRCULATIONAHA.108.841445","volume":"120","author":"L de Kerchove","year":"2009","unstructured":"de Kerchove L, Boodhwani M, Glineur D, Poncelet A, Verhelst R, Astarci P, et al. Effects of preoperative aortic insufficiency on outcome after aortic valve-sparing surgery. Circulation. 2009;120(11_suppl_1):S120\u20136 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19752356.","journal-title":"Circulation"},{"issue":"2","key":"1019_CR3","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1016\/j.jtcvs.2016.10.081","volume":"153","author":"Tirone E. David","year":"2017","unstructured":"David TE, David CM, Feindel CM, Manlhiot C. Reimplantation of the aortic valve at 20 years. J Thorac Cardiovasc Surg [Internet]. 2017 153(2):232\u2013238. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27923487.","journal-title":"The Journal of Thoracic and Cardiovascular Surgery"},{"issue":"4","key":"1019_CR4","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1016\/j.jtcvs.2017.12.039","volume":"155","author":"S Klotz","year":"2018","unstructured":"Klotz S, Stock S, Sievers H-H, Diwoky M, Petersen M, Stierle U, et al. Survival and reoperation pattern after 20 years of experience with aortic valve-sparing root replacement in patients with tricuspid and bicuspid valves. J Thorac Cardiovasc Surg. 2018;155(4):1403\u20131411.e1 Available from: https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0022522317328477.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"1019_CR5","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.jtcvs.2018.10.155","volume":"158","author":"S Mastrobuoni","year":"2019","unstructured":"Mastrobuoni S, de Kerchove L, Navarra E, Watremez C, Vancraeynest D, Rubay J, et al. Long-term experience with valve-sparing reimplantation technique for the treatment of aortic aneurysm and aortic regurgitation. J Thorac Cardiovasc Surg. 2019;158(1):14\u201323 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30635185.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"3","key":"1019_CR6","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1016\/j.athoracsur.2017.08.040","volume":"105","author":"Malakh L. Shrestha","year":"2018","unstructured":"Shrestha ML, Beckmann E, Abd Alhadi F, Krueger H, Meyer-Bockenkamp F, Bertele S, et al. Elective David I procedure has excellent long-term results: 20-year single-center experience. Ann Thorac Surg [Internet]. 2018 ;105(3):731\u2013738. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29198631.","journal-title":"The Annals of Thoracic Surgery"},{"issue":"3","key":"1019_CR7","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1093\/ejechocard\/jeq030","volume":"11","author":"P Lancellotti","year":"2010","unstructured":"Lancellotti P, Tribouilloy C, Hagendorff A, Moura L, Popescu BA, Agricola E, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr. 2010;11(3):223\u201344 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20375260.","journal-title":"Eur J Echocardiogr"},{"issue":"4","key":"1019_CR8","doi-asserted-by":"publisher","first-page":"1490","DOI":"10.1016\/j.athoracsur.2007.12.082","volume":"85","author":"CW Akins","year":"2008","unstructured":"Akins CW, Miller DC, Turina MI, Kouchoukos NT, Blackstone EH, Grunkemeier GL, et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Ann Thorac Surg. 2008;85(4):1490\u20135 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18355567.","journal-title":"Ann Thorac Surg"},{"key":"1019_CR9","first-page":"026765911983192","volume":"1","author":"D Karciauskas","year":"2019","unstructured":"Karciauskas D, Mizariene V, Jakuska P, Ereminiene E, Orda P, Ordiene R, et al. Early and long-term results of aortic valve sparing aortic root reimplantation surgery for bicuspid and tricuspid aortic valves. Perfusion. 2019;1:026765911983192 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30823866.","journal-title":"Perfusion"},{"issue":"2","key":"1019_CR10","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1016\/j.jtcvs.2008.08.054","volume":"137","author":"M Boodhwani","year":"2009","unstructured":"Boodhwani M, de Kerchove L, Glineur D, Poncelet A, Rubay J, Astarci P, et al. Repair-oriented classification of aortic insufficiency: Impact on surgical techniques and clinical outcomes. J Thorac Cardiovasc Surg. 2009;137(2):286\u201394 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19185138.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"1019_CR11","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1053\/j.pcsu.2012.01.003","volume":"15","author":"J Price","year":"2012","unstructured":"Price J, El Khoury G. Aortic valve insufficiency: leaflet teconstruction techniques. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2012;15(1):3\u20138 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22424501.","journal-title":"Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu"},{"issue":"13","key":"1019_CR12","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1016\/j.jacc.2015.07.041","volume":"66","author":"Tirone E. David","year":"2015","unstructured":"David TE, David CM, Manlhiot C, Colman J, Crean AM, Bradley T. Outcomes of Aortic Valve-Sparing Operations in Marfan Syndrome. J Am Coll Cardiol. 2015 ;66(13):1445\u20131453. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26403341.","journal-title":"Journal of the American College of Cardiology"},{"issue":"6","key":"1019_CR13","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1016\/j.jacc.2016.04.062","volume":"68","author":"TE David","year":"2016","unstructured":"David TE. Aortic valve sparing in different aortic valve and aortic root conditions. J Am Coll Cardiol. 2016;68(6):654\u201364 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27491910.","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"1019_CR14","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1016\/j.athoracsur.2014.09.091","volume":"100","author":"S Miyahara","year":"2015","unstructured":"Miyahara S, Matsueda T, Izawa N, Yamanaka K, Sakamoto T, Nomura Y, et al. Mid-term results of valve-sparing aortic root replacement in patients with expanded indications. Ann Thorac Surg. 2015;100(3):845\u201352 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26095104.","journal-title":"Ann Thorac Surg"},{"issue":"3","key":"1019_CR15","doi-asserted-by":"publisher","first-page":"1126","DOI":"10.1016\/j.athoracsur.2015.05.093","volume":"100","author":"B Arabkhani","year":"2015","unstructured":"Arabkhani B, Mookhoek A, Di Centa I, Lansac E, Bekkers JA, De Lind Van Wijngaarden R, et al. Reported outcome after valve-sparing aortic root replacement for aortic root aneurysm: A systematic review and meta-analysis. Ann Thorac Surg. 2015;100(3):1126\u201331 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26228603.","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"1019_CR16","doi-asserted-by":"publisher","first-page":"S30","DOI":"10.1016\/j.jtcvs.2014.09.048","volume":"149","author":"H-J Sch\u00e4fers","year":"2015","unstructured":"Sch\u00e4fers H-J, Raddatz A, Schmied W, Takahashi H, Miura Y, Kunihara T, et al. Reexamining remodeling. J Thorac Cardiovasc Surg. 2015;149(2):S30\u20136 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25439784.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"1019_CR17","first-page":"65","volume":"2","author":"J-L Vanoverschelde","year":"2013","unstructured":"Vanoverschelde J-L, van Dyck M, Gerber B, Vancraeynest D, Melchior J, de Meester C, et al. The role of echocardiography in aortic valve repair. Ann Cardiothorac Surg. 2013;2(1):65\u201372 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23977561.","journal-title":"Ann Cardiothorac Surg"},{"issue":"8","key":"1019_CR18","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1016\/j.jcmg.2009.04.013","volume":"2","author":"J-B le Polain de Waroux","year":"2009","unstructured":"le Polain de Waroux J-B, Pouleur A-C, Robert A, Pasquet A, Gerber BL, Noirhomme P, et al. Mechanisms of recurrent aortic regurgitation after aortic valve repair. JACC Cardiovasc Imaging. 2009;2(8):931\u20139 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19679280.","journal-title":"JACC Cardiovasc Imaging"},{"issue":"4","key":"1019_CR19","doi-asserted-by":"publisher","first-page":"400","DOI":"10.1016\/j.ejcts.2010.01.060","volume":"38","author":"BO Bierbach","year":"2010","unstructured":"Bierbach BO, Aicher D, Issa OA, Bomberg H, Gr\u00e4ber S, Glombitza P, et al. Aortic root and cusp configuration determine aortic valve function\u2606. Eur J Cardio-Thoracic Surg. 2010;38(4):400\u20136 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20219388.","journal-title":"Eur J Cardio-Thoracic Surg"},{"issue":"2","key":"1019_CR20","doi-asserted-by":"publisher","first-page":"436","DOI":"10.1016\/j.jtcvs.2006.04.032","volume":"132","author":"H-J Sch\u00e4fers","year":"2006","unstructured":"Sch\u00e4fers H-J, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg. 2006;132(2):436\u20138 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16872982.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"2","key":"1019_CR21","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/j.jtcvs.2012.06.053","volume":"146","author":"H-J Sch\u00e4fers","year":"2013","unstructured":"Sch\u00e4fers H-J, Schmied W, Marom G, Aicher D. Cusp height in aortic valves. J Thorac Cardiovasc Surg. 2013;146(2):269\u201374 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/22853942.","journal-title":"J Thorac Cardiovasc Surg"},{"issue":"1","key":"1019_CR22","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1007\/s11748-018-0920-3","volume":"67","author":"Athanasios Antoniou","year":"2018","unstructured":"Antoniou A, Harky A, Bashir M, El Khoury G. Why I choose to repair and not to replace the aortic valve? Gen Thorac Cardiovasc Surg. 2019 67(1):20\u201324. Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29623558.","journal-title":"General Thoracic and Cardiovascular Surgery"},{"issue":"17","key":"1019_CR23","doi-asserted-by":"publisher","first-page":"1838","DOI":"10.1016\/j.jacc.2016.07.767","volume":"68","author":"M Ouzounian","year":"2016","unstructured":"Ouzounian M, Rao V, Manlhiot C, Abraham N, David C, Feindel CM, et al. Valve-sparing root replacement compared with composite valve graft procedures in patients with aortic root dilation. J Am Coll Cardiol. 2016;68(17):1838\u201347 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27765186.","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"1019_CR24","first-page":"3","volume":"2","author":"R Saczkowski","year":"2013","unstructured":"Saczkowski R, Malas T, de Kerchove L, El Khoury G, Boodhwani M. Systematic review of aortic valve preservation and repair. Ann Cardiothorac Surg. 2013;2(1):3\u20139 Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23977553.","journal-title":"Ann Cardiothorac Surg"}],"container-title":["Journal of Cardiothoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-019-1019-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13019-019-1019-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13019-019-1019-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,11]],"date-time":"2020-11-11T00:32:48Z","timestamp":1605054768000},"score":1,"resource":{"primary":{"URL":"https:\/\/cardiothoracicsurgery.biomedcentral.com\/articles\/10.1186\/s13019-019-1019-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,12]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["1019"],"URL":"https:\/\/doi.org\/10.1186\/s13019-019-1019-3","relation":{},"ISSN":["1749-8090"],"issn-type":[{"type":"electronic","value":"1749-8090"}],"subject":[],"published":{"date-parts":[[2019,11,12]]},"assertion":[{"value":"18 August 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 October 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 November 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This retrospective investigation was approved by the Regional Medical Research Ethics Committee of the Lithuanian University of Health Sciences and was registered under clinical registration number No.BE-2-34 (the 12th of December 2016) and the need for individual informed consent was waived.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"194"}}