Valve-sparing aortic root replacement: Strategies to avoid residual aortic regurgitation

Figures

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  ROC on predictive value of postoperative coaptation height on the presence of residual AR.

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  Figure 1. Intraoperative photographs of a reimplantation procedure in one of the registry patients. A, After resection of ascending aorta. B, After resection of sinus Valsalva tissue and isolation of coronaries, the 3 cusp free margin lengths can be measured easily by splaying the commissures. C, After reimplantation of the valve inside the vascular graft, cusp reconstruction (shown is central plication of right coronary cusp) is performed and documented.

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  Figure 2. Distribution of preoperative and postoperative AR grades. AR, Aortic regurgitation; TEE, transesophageal echocardiography.

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  Figure 3. Histograms showing maximum STJ diameters preoperatively (left) and 2 measures of inhomogeneity of cusp sizes: the maximum difference of the 3 measured free margin lengths (middle) and the maximum difference between the 3 geometrical cusp heights. STJ, Sinotubular junction.

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  Figure 4. Regression showing relationship between the maximum STJ diameter and cusp quantity. STJ, Sinotubular junction.

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  Figure 5. The mean and sum of free margin lengths and geometric heights as functions of postrepair coaptation height. FM, Free margin; TEE, transesophageal echocardiography.

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  Figure E1. Patient recruitment, GEARR, from September 2016 to July 2023. GEARR, German Aortic Root Repair Registry.

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  Figure E2. Selected test variables, optimal classifier analysis, and end point any grade of residual AR. ROC, Receiver operating curve; TEE, transesophageal echocardiography; STJ, sinotubular junction; VAJ, ventriculoaortic junction.

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  Figure E3. Annular downsizing performed as a function of mean and sum of cusp free margin lengths in patients who left the operating room with no residual AR. rAR, Residual aortic regurgitation.