3D transesophageal echocardiographic assessment of cusp prolapse mechanisms in tricuspid aortic root aneurysms and correlation with valve-sparing surgical outcomes

Background: Valve-sparing root replacement (VSRR) prevents prosthesis-related complications in aortic root aneurysms but lacks objective feasibility criteria. Cusp prolapse frequently coexists with aortic root aneurysms, but its effect on VSRR outcomes remains unclear. We characterized prolapse mechanisms using three-dimensional (3D) transesophageal echocardiography (TEE) and examined the correlation between imaging features and surgical success as well as midterm outcomes. Methods: This retrospective cohort study analyzed the data of 203 consecutive patients considered for VSRR. Cusp prolapse was diagnosed and mechanistically classified using quantitative 3D TEE analysis. The intraoperative findings confirmed regurgitation mechanisms. The outcomes compared the native valve preservation rates, postoperative echocardiographic results, mortality, regurgitation recurrence, and reintervention between prolapse and non-prolapse groups over a median 41-month follow-up period. Results: 86.5%; P