Thorac cardiovasc Surg
DOI: 10.1055/s-0037-1599128
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Evidence-based Surgery of Aortic Regurgitation: Results of a Questionnaire in German-speaking Countries

Christian Dinges1, Johannes Steindl1, Wolfgang Hitzl2, Tobias Kiesslich3, 4, Rainald Seitelberger1
  • 1Department of Cardiac Surgery, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria
  • 2Research Office (Biostatistics), Paracelsus Medical University, Salzburg, Austria
  • 3Department of Internal Medicine I, Paracelsus Medical University, Salzburger Landeskliniken, Salzburg, Austria
  • 4Institute of Physiology and Pathophysiology, Paracelsus Medical University, Salzburg, Austria
Further Information

Publication History

23 November 2016

22 December 2016

Publication Date:
04 March 2017 (eFirst)


Background evidence-based medicine (EBM) approaches have reached broad acceptance, both in conservative and surgical disciplines. The aim of this study is to clarify the role of EBM in a rare condition of aortic regurgitation (AR) with surgical indication.

Methods A purpose-built Internet-based questionnaire was sent to 607 cardiovascular surgeons in Germany, Austria, and Switzerland. A virtual 64-year-old patient's medical history was presented, including two ultrasound images and one computed tomography scan, showing a 58-mm aortic root aneurysm and a severe trileaflet regurgitant aortic valve. Participants had to choose their preferred therapeutic strategy from a list. Additionally, demographics including nationality, the center size, and the frequency of similar types of patients referred to their departments were collected.

Results Of 607 questionnaires, 100 were returned (16%). One participant was excluded due to conflicting answers. Most surgeons (n = 84; 84%) chose a valve-sparing root replacement (VSRR). A Bentall procedure was preferred by 13 surgeons (13%). Two surgeons voted for aortic valve replacement combined with partial root resection. The decision-making process was not significantly influenced by center size, nationality, or frequency of patients.

Conclusion Applying the current guidelines to our virtual study patient, 84% of participants acted accordingly choosing VSRR. Remarkably, 14% of these surgeons see less than 10 and 43% see not more than 20 comparable patients per year. Since the guidelines reserve VSRR for competent centers, those numbers as well as the guidelines themselves should be further discussed.