1. Aortic Root Surgery Trends in the US: Report From the STS Database Sotiris C. Stamou, MD, Ph.D, Mathew L. Williams, MD, Yue Zhao, Ph.D, Nicholas T. Kouchoukos, MD, Robert C. Hagberg, MD, Kevin W. Lobdell, MD Divisions of Cardiothoracic Surgery, Meijer Heart Center, Michigan State University, Grand Rapids, MI, University of Louisville, Louisville, KY, Missouri Baptist Medical Center, St. Louis, MI, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, Sanger Heart and Vascular Institute, Charlotte, NC, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC

2. OBJECTIVE Evaluate the early clinical outcomes of aortic root surgery in the United States. Identify the trends in aortic root procedures over the years Evaluate the early clinical outcomes of aortic root surgery in the United States. Identify the trends in aortic root procedures over the years

3. Methods N= 13,743 Period of study: January 2004 to December 2010 Median age: 58 years (range 18-96 years) Females: 3,961 (29%) Concomitant ascending aortic aneurysm (n=8,472) N= 13,743 Period of study: January 2004 to December 2010 Median age: 58 years (range 18-96 years) Females: 3,961 (29%) Concomitant ascending aortic aneurysm (n=8,472)

4. Aortic Root Procedures Mechanical Valve-Conduits: 37% Stented pericardial valve conduits:7% Stented porcine valve conduits: 4% Stentless root: 34% Homograft: 3% Valve sparing root replacement: 15% Mechanical Valve-Conduits: 37% Stented pericardial valve conduits:7% Stented porcine valve conduits: 4% Stentless root: 34% Homograft: 3% Valve sparing root replacement: 15%

5. Operative Mortality Stroke Reoperation for bleeding Aortic stenosis6.242.245.29 Age < 60 years2.351.345.03 60-69 years4.582.356.31 70-79 years8.023.627.11 >80 years15.413.786.83 Concommitant procedures CABG9.453.467.94 Valve (mitral or tricuspid)13.292.778.8 CABG+Valve21.44.019.7 Aortic aneurysm2.992.045.81 Redo sternotomy8.922.647.2 Aortic root procedure Mechanical valve conduit3.762.016.17 stented tissue valve conduit5.693.076.5 stentless root5.822.175.54 homograft7.634.036.36 Aortic valve sparing1.882.266 Values are expressed as %

8. Conclusion The great majority of aortic root surgery is perfomed in a small number of centers The unadjusted operative mortality is higher in patients over 80 years old, while valve sparing root surgery is associated with the lowest mortality There was a trend towards increased use of stented tissue valves over the last few years The great majority of aortic root surgery is perfomed in a small number of centers The unadjusted operative mortality is higher in patients over 80 years old, while valve sparing root surgery is associated with the lowest mortality There was a trend towards increased use of stented tissue valves over the last few years