***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE The study objective was to compare the 30-day outcomes of a st and ardized aortic valve repair technique ( REPAIR group ) associating root remodeling with an expansible aortic ring annuloplasty versus mechanical composite valve and graft ( CVG group ) replacement in treating aortic root aneurysms . METHODS A total of 261 consecutive patients with aortic root aneurysm were enrolled in this multicentric prospect i ve cohort ( 131 in the CVG group , 130 in the REPAIR group ) in 20 centers . The main end point is a composite criterion including mortality ; reoperation ; thromboembolic , hemorrhagic , or infectious events ; and heart failure . Secondary end points were major adverse valve-related events . Crude and propensity score adjusted estimates are provided . RESULTS The mean age was 56.1 years , and the valve was bicuspid in 115 patients ( 44.7 % ) . The median ( interquartile range ) preoperative aortic insufficiency grade was 2.0 ( 1.0 - 3.0 ) in the REPAIR group and 3.0 ( 2.0 - 3.0 ) in the CVG group ( P = .0002 ) . Thirty-day mortality was 3.8 % ( n = 5 ) in both groups ( P = 1.00 ) . Despite a learning curve and longer crossclamp times for valve repair ( 147.7 vs 99.8 minutes , P < .0001 ) , the 2 groups did not differ significantly for the main criterion ( odds ratio , 1.31 ; 95 % confidence interval , 0.72 - 2.40 ; P = .38 ) or 30-day mortality ( odds ratio , 0.99 ; 95 % confidence interval , 0.28 - 3053 ; P = .99 ) , with a trend toward more frequent major adverse valve-related events in the CVG group ( odds ratio , 2.52 ; 95 % confidence interval , 0.86 - 7.40 ; P = .09 ) . At discharge , 121 patients ( 96.8 % ) in the REPAIR group had grade 0 or 1 aortic insufficiency . CONCLUSIONS A new st and ardized approach to valve repair , combining an expansible aortic annuloplasty ring with the remodeling technique , presented similar 30-day results to mechanical CVG with a trend toward reducing major adverse valve-related events . Analysis of late outcomes is in process for 3- and 10-year follow-ups BACKGROUND Refining leaflet reconstruction has become a primary issue in aortic valve repair . This descriptive analysis review s leaflet pathology , repair techniques , and early results in a prospect i ve regulatory trial of aortic valve repair . METHODS Sixty-five patients underwent valve repair for predominant moderate to severe aortic insufficiency ( AI ) . The mean age was 63 ± 13 years , and 69 % of the patients were male .  Ascending aortic/root replacement was required in 62 % . As a first step , ring annuloplasty was performed , and then leaflet repair included leaflet plication for prolapse , nodular unfolding , double pericardial patching of commissural defects or holes , complete pericardial leaflet replacement , leaflet extension , and Gore-Tex reinforcement . Leaflet techniques and causes of adverse outcomes were evaluated . RESULTS The follow-up time was 2-years maximal and 0.9 years mean , with a survival of 97 % . Eighty percent of patients required repair of leaflet defects : leaflet prolapse ( 52/65 - 80 % ) , ruptured commissures ( 6/65 - 9 % ) , leaflet holes ( 4/65 - 6 % ) , and nodular retraction ( 6/65 - 9 % ) . The average preoperative AI grade of 2.9 ± 0.8 fell to 0.7 ± 0.7 ( p < 0.0001 ) . Three patients ( 4.6 % ) required interval valve replacement because of ( 1 ) suture untying , ( 2 ) iatrogenic leaflet tear , or ( 3 ) diphtheroid endocarditis . Five other patients experienced grade 2 or grade 3 AI : probable suture untying in 1 patient , ineffective leaflet extensions in 2 patients , and unsuccessful Gore-Tex reinforcements in 2 patients . Two patients with single pericardial leaflet replacements and all those with double pericardial reconstructions did well . CONCLUSIONS Leaflet defects are common in patients with moderate to severe AI . Leaflet plication , nodular unfolding , and double pericardial patching performed well . Gore-Tex and leaflet extension seemed less satisfactory . St and ardization and experience with leaflet reconstruction will be important for optimizing the outcomes of aortic valve repair Comprehensive aortic root and valve repair ( CARVAR ) is a recently introduced surgical technique for aortic valve disease . The National Evidence -based Health Care Collaborating Agency was offered by the ministry of Health and Welfare , Korea to perform a restrospective outcome analysis for this surgical procedure . The aims of this study were to evaluate the safety of patients who underwent CARVAR surgery  and to provide a rationale for further prospect i ve r and omized study . During the period of March 2007 to November 2009 , 397 patients received this procedure and enrolled in this study . Clinical events including major bleeding , endocarditis , re-operation and death were followed-up till March 2010 by medical records . During the follow-up periods , 1-year cumulative incidence of major bleeding , re-operation , endocarditis and death were 3.55 , 5.65 , 5.05 and 5.33%/year respectively . This study showed that the CARVAR technique is not beneficial , and is indeed even more harmful than conventional valve replacement surgery OBJECTIVES A geometric annuloplasty ring could improve efficacy and stability of aortic valve repair . Toward this goal , a 1-piece 3-dimensional titanium annuloplasty ring with Dacron covering was developed and tested successfully in animals . The purpose of this study was to define hemodynamic outcomes with this device used as the annuloplasty component of human aortic valve repair . METHODS In a 4-center pilot trial with informed consent , 16 patients underwent aortic valve repair for aortic insufficiency , with the annuloplasty device sutured into the annulus beneath the leaflets . Preoperative annular diameter averaged 26.5 ± 2.0 ( mean ± st and ard deviation ) mm , and average ring size was 22.3 ± 1.2 mm . After annuloplasty , leaflet defects were easy to identify , and 14 of 16 patients ( 88 % ) required leaflet plication and /or autologous pericardial reconstruction for leaflet defects . Three patients had ascending aortic replacement , and 2 had remodeling root replacement . One had ultrasonic leaflet decalcification and another tricuspid valve annuloplasty . Follow-up data were from site-specific studies at the 6-month postoperative time point . RESULTS There were no in-hospital mortalities or major complications . Preoperative aortic insufficiency grade ( 0 - 4 scale ) was 3.6 ± 1.0 and fell to 1.0 ± 0.8 at 6 months ( P < .0001 ) . New York Heart Association class fell from 2.5 ± 0.5 to 1.1 ± 0.3 ( P < .0001 ) . Postrepair valve area was 2.7 ± 0.2 cm(2 ) , and 6-month mean systolic gradient was 11.3 ± 3.3 mm Hg . Left ventricular end-diastolic diameter and ejection fraction both normalized ( both P < .0001 ) . CONCLUSIONS Geometric ring annuloplasty facilitated aortic valve repair , allowing more precise reconstruction of leaflet defects . Aortic insufficiency reduction and systolic gradients were excellent , and expansion of valve reconstruction into broader categories of aortic valve disease seems indicated 
    Output:
    
Their clinical outcomes seem currently acceptable in general , and external flexible annuloplasty has been performed more frequently with favorable outcomes .
However , they are still performed for a minority of patients by special experienced teams with limited follow-up periods .