OBJECTIVES: Both aortic root remodelling and aortic valve (AV) reimplantation have been used for valve-sparing root replacement in patients with aortic root aneurysm with or without aortic regurgitation. There is no clear evidence to support one technique over the another. This study aimed to compare remodelling with basal ring annuloplasty versus reimplantation on a multicentre level with the use of propensity-score matching. METHODS: This was a retrospective international multicentre study of patients undergoing remodelling or reimplantation between 2010 and 2021. Twenty-three preoperative covariates (including root dimensions and valve characteristics) were used for propensity-score matching. Perioperative outcomes were analysed along with longer-term freedom from AV reoperation/reintervention and other major valve-related events. RESULTS: Throughout the study period, 297 patients underwent remodelling and 281 had reimplantation. Using propensity-score matching, 112 pairs were selected and further compared. We did not find a statistically significant difference in perioperative outcomes between the matched groups. Patients after remodelling had significantly higher reintervention risk than after reimplantation over the median follow-up of 6 years (P = 0.016). The remodelling technique (P = 0.02), need for decalcification (P = 0.03) and degree of immediate postoperative AV regurgitation (P < 0.001) were defined as independent risk factors for later AV reintervention. After exclusion of patients with worse than mild AV regurgitation immediately after repair, both techniques functioned comparably (P = 0.089). CONCLUSIONS: AV reimplantation was associated with better valve function in longer-term postoperatively than remodelling. If optimal immediate repair outcome was achieved, both techniques provided comparable AV function.

2nd Department of Surgery 1st Faculty of Medicine and General University Hospital Prague Charles University Prague Czech Republic

Department of Cardiac Surgery Faculty of Medicine and East Slovak Institute of Cardiovascular Disease Pavol Jozef Šafárik University Košice Slovakia

Department of Cardiac Surgery Faculty of Medicine and University Hospital in Hradec Kralove Charles University Hradec Kralove Czech Republic

Department of Cardiac Surgery Hospital AGEL Trinec 5 Podlesí Trinec Czech Republic

Department of Cardiac Surgery Na Homolce Hospital Prague Czech Republic

Department of Cardiovascular Surgery and Transplantation Faculty of Medicine Masaryk University Brno Czech Republic

Department of Cardiovascular Surgery University Hospital Frankfurt and Goethe University Frankfurt Frankfurt Main Germany

Department of Cardiovascular Surgery University Hospital in Motol Prague Czech Republic

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