Author's response to reviews Title:Early and Midterm Outcomes of the VSSR procedure with De Paulis valsalva graft: A Chinese single-Center Experience in 38 patients Authors:

Background: This study investigated early and midterm outcomes after valve-sparing aortic root replacement (VSSR procedure with De Paulis Valsalva graft) for acute aortic dissection or ascending aortic aneurysm in a single Chinese hospital center. Methods: Between September 2005 to July 2013, 38 patients (84.2% male; mean age, 45.5±12.4) underwent VSSR procedure with De Paulis valsalva graft for acute aortic dissection or ascending aortic aneurysm and were followed up clinically and echocardiographically. Results: Among the 38 cases studied, intensive care unit stay duration was 34.5 (interquartile range, 16-34.6) days; hospital stay duration was 11.7±7.9 days; operation time was 6.8±1.9 hours; and cross-clamping time was 154.4±42.0 minutes. There was one intraoperative conversion to Bentall procedure; one re-operation for bleeding; one operative death and one case who developed complications. Mean follow-up was 39.7±21.7 months (range, 12-108 months; cumulative rate, 1483 patients-months; follow-up rate, 94%). At 5 and 10 years, overall freedom from valve replacement was 94% and 87%; freedom from aortic regurgitation grade II or higher was 94% and 91%; and freedom from reoperation was 94% and 90% years, respectively. Conclusions: The reimplantation type of valve-sparing procedure appears to be facilitated by the use of the De Paulis valsalva graft with satisfactory perioperative and midterm results.