Valve-Sparing Aortic Root Replacement: Defining High-Volume Centres Using Prospective Data

This multicenter registry study evaluated the volume-outcome relationship in elective valve-sparing aortic root replacement (VSARR) to establish a threshold for high-volume centers. Utilizing prospective data from 2,668 patients across 37 centers within the Heart Valve Society Aortic Valve Database, the authors modeled early composite safety outcomes and long-term aortic valve reintervention-free survival. The authors found that annual institutional volume was not significantly associated with early postoperative composite complications (p=0.8); however, a significant nonlinear association emerged for long-term valve durability (p=0.002). Based on this, the authors identified an optimal threshold of greater than or equal to 12 cases per year for superior long-term survival and freedom from reintervention. Thus, while early safety endpoints remain uniformly low across centers due to low event rates, long-term valve durability relied heavily on ongoing institutional exposure.