Related Experiment Video

Updated: May 26, 2026

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
14:14

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

Published on: December 11, 2017

Valve-sparing Aortic Root Replacement: Defining High-volume Centres Using Prospective Data

Pascal J Govers1, Michal J Kawczynski2,3, Samuel Heuts2,3

  • 1Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, 3015GD, The Netherlands.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|May 24, 2026
PubMed

Insights

Performing at least 12 valve-sparing aortic root replacements annually defines a high-volume center, improving long-term valve durability and survival. Early outcomes are less sensitive to case volume.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Surgery Outcomes

Background:

  • Valve-sparing aortic root replacement (VSARR) is complex, with variable institutional volumes.
  • Establishing expertise thresholds for VSARR centers is challenging.
  • Defining high-volume centers is crucial for quality improvement.

Purpose of the Study:

  • To identify an optimal annual case volume for high-volume centers performing VSARR.
  • To analyze the relationship between institutional volume and patient outcomes for VSARR.
  • To establish a benchmark for VSARR center expertise.

Main Methods:

  • Retrospective analysis of 2,668 elective VSARR cases from the Heart Valve Society Aortic Valve database.
  • Primary early outcome: 30-day composite of mortality, thromboembolism, reintervention, conversion, and regurgitation.
  • Primary long-term outcome: freedom from aortic valve reintervention.
  • Volume-outcome association modeled using restricted cubic splines and the elbow method.
  • Analyses adjusted for EuroSCORE II.

Main Results:

  • No significant association between annual volume and early composite outcomes (p=0.8003).
  • Significant non-linear association between volume and long-term aortic valve reintervention-free survival (p=0.0023).
  • Improved long-term outcomes observed in centers performing ≥12 VSARR cases annually (95% CI: 10-12).
  • Results confirmed in sensitivity analyses (p<0.0001).

Conclusions:

  • An annual institutional volume of ≥12 VSARR procedures is associated with enhanced long-term valve durability and survival.
  • Early postoperative outcomes are less dependent on annual case load due to low event rates.
  • This high-volume threshold can serve as a benchmark for experienced cardiac surgery centers and guide quality initiatives.
Abstract

Keywords:
annual case volumeaortic root surgeryoptimal case volumereimplantation techniquevalve-sparing operationsvolume-outcome association

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