Postoperative high-grade atrioventricular block is prevalent following congenital aortic valve, root and left ventricular outflow tract (LVOT) surgery. We aimed to evaluate the application of presurgical cardiac computed tomography (CT) estimation of the conduction axis in mitigating this issue. Patients with congenital aortic valve, root and LVOT disease evaluated and operated in our center from February 2022 to August 2025 who underwent presurgical CT with intact central fibrous body were included. Anatomical landmarks were used to estimate the atrioventricular node (point A), His bundle course (point B), and left bundle branch origin (point C) relative to the aortic virtual basal ring plane, and guide avoidance during cardiac surgery. Fifty-three patients were included (mean age, 32 years [range, 2-68 years]; 72% male). The most common diagnoses were bileaflet (70%) and unileaflet (10%) aortic valves, and LVOT obstruction (7%). Points A, B, and C were located at a mean depth of +11.8 ± 4.8 mm, +3.3 ± 3.2 mm, and +1.5 ± 2.7 mm inferior to the aortic virtual basal ring plane, respectively. Some form of aortic valve repair was performed in 38 patients (72%). The remaining 15 patients (28%) underwent some form of aortic valve replacement. One patient (1.9%) developed high-grade atrioventricular block with permanent pacemaker insertion, with subsequent spontaneous resolution. This incidence compared favorably to our prior report of 10% in a similar cohort without pre-surgical CT conduction system estimation. This CT-based conduction axis estimation may mitigate conduction damage risk during congenital LVOT, aortic valve, and root surgery. Further prospective multisurgeon, multicenter studies are necessary to validate this approach.

Despite the technically challenging nature of valve-sparing root replacement, restoration of aortic valve competence can be achieved through a complete understanding of the aortic root anatomy and pathophysiology. In this review, we discuss the physiology of normal aortic root function as well as pathophysiologic mechanisms contributing to aortic valve incompetence. Preoperative planning for valve-sparing root replacement is discussed, including the use of imaging to guide surgical decision-making. Pitfalls and pearls of the critical technical steps for both valve-sparing root replacement and repair of both tricuspid and bicuspid aortic valves are provided. Finally, current evidence guiding best practices in valve-sparing root replacement and aortic valve repair is presented to support decision-making for patient selection.

BackgroundThe optimal extent of repair for DeBakey type I acute aortic dissection remains controversial, particularly in low- to medium-volume centers. We compared outcomes of ascending and arch replacement under a tear-oriented strategy in DeBakey type I dissection.MethodsWe retrospectively analyzed 114 consecutive patients with acute DeBakey type I dissection between April 2008 and July 2025 at a regional cardiovascular center. Ascending aortic replacement was performed in 55 patients, and arch replacement, including both partial and total arch replacement, in 59 patients. The primary endpoint was overall survival. Secondary endpoints included in-hospital mortality, major complications, and open aortic reoperation.ResultsArch replacement required longer operative, cardiopulmonary bypass, aortic cross-clamp, and circulatory arrest times. In-hospital mortality was 5.5% after ascending aortic replacement and 13.6% after arch replacement (P = 0.143). Rates of major complications were comparable between groups. Long-term survival was better after ascending aortic replacement than after arch replacement (5-year, 87.1% vs 69.4%; 10-year, 83.5% vs 59.8%; P = 0.015). Freedom from open aortic reoperation was similar between groups (5-year, 90.4% vs 88.3%; 10-year, 70.2% vs 88.3%; P = 0.201). In the subgroup analysis restricted to patients with an intimal tear in the aortic root or ascending aorta, there were no differences in the primary or secondary endpoints.ConclusionsA tear-oriented limited replacement strategy appears reasonable in centers with limited volume of acute type A dissection repair.

The internal geometric annuloplasty ring is the only commercially available aortic annuloplasty ring designed to reduce and prevent annular dilatation during aortic valve repair; however, data regarding its long-term durability remain limited. Here we present our mid-term outcomes. A retrospective review was conducted of all adult patients who underwent aortic valve repair using the internal geometric annuloplasty ring between January 2017 and May 2025. Patients requiring valve reintervention were included in the analysis. Eighteen aortic valve repairs were performed in 17 patients (mean age, 54 ± 15 years; 16 males; 14 tricuspid valves, 2 bicuspid valves, 1 unicuspid valve), including 1 redo repair. Ten cases (56%) involved concomitant aortic root remodeling. Tricuspid 21-mm rings were used most frequently (61%). During a mean follow-up of 3.7 ± 1.7 years, 8 reinterventions were required in 7 patients (44%) owing to severe aortic insufficiency (AI; n = 7) or endocarditis with moderate AI (n = 1). The 5-year estimated reintervention rate was 40.8% (95% confidence interval, 20.0%-70.5%). Reinterventions included surgical aortic valve replacement (n = 5), redo internal geometric annuloplasty (n = 1), aortic root replacement (n = 1), and valve-in-ring transcatheter aortic valve replacement (n = 1). In surgical cases, postexplantation annular dimensions of the ring consistently returned to their preimplantation sizes. In our experience, 44% of patients receiving the internal geometric annuloplasty ring required aortic valve reintervention. Although effective in reducing annular size, the ring's rigid intra-annular design and the potential for excessive annular downsizing may predispose to recurrent insufficiency and limit future transcatheter options, prompting careful consideration of its broad application.

Aortic Root Thrombus Following Transcatheter Aortic Valve Replacement in a Patient with HeartMate 3 Left Ventricular Assist Device Support

Redo transcatheter aortic valve replacement (TAVR) when implanting a second transcatheter valve within a tall-frame self-expanding valve can be challenging because of unfavorable coronary-related anatomy. However, computed tomography (CT)-based data in Asian patients with smaller aortic root dimensions remain limited.This study aimed to evaluate the CT-based geometric coronary constraints by simulating implantation of a balloon-expandable SAPIEN 3 (S3) within a previously implanted self-expanding Evolut valve in Asian patients. Consecutive patients who underwent TAVR using Evolut at a single center between May 2021 and May 2023 and had post-procedural CT were analyzed. Virtual S3-in-Evolut implantation was simulated at three depths (node 4: low; node 5: intermediate; node 6: high). Geometric coronary constraint was assessed based on the relationship between the neo-skirt plane and coronary ostia and the valve-to-aorta distance. Among 113 patients, the distribution of geometric coronary constraint differed by simulated S3 implantation depth. With high S3 implantation (node 6), severe, intermediate, and low constraint were observed in 63.7%, 23.9%, and 12.4% of patients, respectively; with intermediate implantation (node 5), in 31.0%, 29.2%, and 39.8%; and with low implantation (node 4), in 3.5%, 16.8%, and 79.6%. In multivariable analysis, smaller sino-tubular junction diameter was independently associated with severe geometric coronary constraint.Geometric coronary constraints that may affect coronary access after redo TAVR with S3-in-Evolut configurations depend on the implantation depth of both the index Evolut and the simulated S3. However, the hemodynamic significance and clinical impact of these geometric findings require validation through flow studies.

Experimental Evaluation of a Large Fenestrated Physician-Modified Endo-Wheat Using a Cadaveric Model.

Double aortic arch (DAA) is a rare congenital aortic arch anomaly that is usually identified in infancy because of symptoms related to a vascular ring. Acute type A intramural hematoma (IMH) with a focal intimal tear in an adult with DAA is extremely rare, and no consensus has been established regarding emergency management. Seventy-three year-old woman presented with burning pain in the throat and suprasternal notch and was initially suspected of having acute coronary syndrome. Computed tomography angiography (CTA) of the whole aorta and supra-aortic vessels demonstrated a double aortic arch, with the right common carotid artery and right subclavian artery originating from the right arch and the left common carotid artery and left subclavian artery originating from the left arch. After preoperative evaluation, emergency surgery was performed through a median sternotomy. Intraoperatively, a focal intimal tear approximately 2cm in length was identified in the ascending aorta. Given the complex branching anatomy of the double aortic arch, right femoral artery cannulation was used to establish cardiopulmonary bypass in order to minimize invasive manipulation of the arch. Resection of the diseased ascending aorta and graft replacement were performed, and the potential false lumen at the aortic root was obliterated using the adventitial inversion technique. The prosthetic graft was wrapped with bovine pericardium, and the double aortic arch was not addressed during the same operation. The patient experienced recurrent perioperative hypoxemia and was extubated 17h after surgery following respiratory support, lung-protective management, and anti-inflammatory treatment. She was discharged on postoperative day 12. Approximately 1month later, she was readmitted with chest pain, and CTA revealed a newly developed dissection in the proximal right aortic arch. The family declined reoperation, and the patient was subsequently lost to follow-up. In patients with DAA complicated by acute type A IMH with a focal intimal tear, limited ascending aortic replacement in the emergency setting may reduce surgical trauma; however, it may leave a high-risk residual arch segment and increase the risk of clamp-related injury or insufficient resection margins. Perioperative airway compression caused by the vascular ring should be assessed using imaging, and one-stage or staged reconstruction should be planned according to the patient's condition. Strict postoperative blood pressure control and close follow-up are essential to reduce the risk of recurrence.

Syndromic hereditary thoracic aortic disease (sHTAD), including Loeys-Dietz syndrome (LDS), often lead to aneurysmal disease with diffuse arterial involvement. Although open repair remains the gold standard in sHTAD, it carries significant morbidity. Herein, a hybrid approach for subclavian-axillary arterial aneurysm repair in patients with LDS is described. Two patients with prior aortic repair extending from the aortic root to the abdominal aorta were managed for extensive aneurysms involving the subclavian and proximal axillary artery. Via ipsilateral upper limb access, the prior proximal repair was extended with multiple self-expanding covered stents to the axillary artery, ensuring adequate overlap. The distal stent was exposed through a transverse arteriotomy, and an end-to-end anastomosis was created by incorporating the covered stent and arterial walls. In both cases, no salvage of the vertebral arteries was attempted; they were either covered or coiled. Mid-term follow-up showed no anastomotic pseudoaneurysms, kinking, or stenosis. One patient developed a persistent type II endoleak without sac enlargement and remains under surveillance. Hybrid repair with endovascular stent implantation, proximal non-native landing zone and open distal anastomosis may offer a safe and effective alternative for complex subclavian-axillary aneurysms in patients with LDS.Clinical ImpactSyndromic hereditary thoracic aortic disease can result in aneurysms with extensive arterial involvement, and open repair remains the gold standard in these patients. A hybrid technique, involving endovascular extension of a previously replaced proximal landing zone to a distal native arterial segment, followed by open exposure and creation of an end-to-end anastomosis, is described. This approach was successfully applied in 2 cases, both with prior open and endovascular management of the proximal landing zone. Mid-term postoperative outcomes demonstrated acceptable efficacy and confirmed the feasibility of the technique. This hybrid approach may significantly reduce postoperative morbidity compared with conventional open repair.

We investigated the effects of the combined use of preoperatively separated autologous red blood cells, plasma, and fibrin sealant on reducing allogeneic blood transfusion during valve-sparing root replacement using the aortic root remodeling technique, by comparison with transfusion of refrigerated, predeposited autologous whole blood. Thirty-nine patients underwent elective, initial valve-sparing root replacement using the aortic root remodeling technique by a single surgeon between April 2018 and December 2023. Of these, 9 patients in Group A predeposited autologous whole blood until September 2019 and 12 patients in Group B predeposited separated autologous red blood cells, plasma, and fibrin sealant after October 2019. The intraoperative allogeneic blood transfusion avoidance rate was compared between Groups A and B. The allogeneic blood transfusion avoidance rate in Group A was 66.7% for red blood cells, 55.6% for plasma, 55.6% for platelets, and 55.6% for all components combined. In Group B, the avoidance rate was 100% for each component, significantly higher than in Group A for plasma, platelets, and all components combined (all P = 0.021). Postoperative hemoglobin level was significantly higher and amount of chest tube drainage during the first 12 postoperative hours was lower in Group B. This before-and-after study suggested that the combined use of preoperatively separated autologous red blood cells and plasma and fibrin sealant can be an effective blood management strategy in patients undergoing valve-sparing root replacement using the aortic root remodeling technique, reducing intraoperative allogeneic blood transfusion compared with predeposited autologous whole blood transfusion.

Pulmonary artery catheters are used widely in cardiac surgery despite observed associations with worse outcomes and guidelines that recommend against their routine use. No adequately powered randomised trials are available. The PUMA Pilot was a multicentre, randomised, parallel assignment, open-label, pilot and feasibility trial conducted at three tertiary cardiac surgery centres. Eligible patients were adults undergoing coronary artery bypass grafting, aortic valve replacement or surgery on the aortic root or ascending aorta with or without aortic valve replacement, with a predicted surgical mortality of < 2%. Patients were allocated randomly to receive a pulmonary artery catheter or a central venous catheter inserted immediately before surgery. The primary feasibility outcome was protocol compliance, defined as receiving the assigned intervention without crossover. Secondary feasibility outcomes were eligibility rate; recruitment proportion and rate; data completeness; and rate of clinician refusal. We screened 480 patients and 206 (43%) were eligible; 150/203 (74%) approached provided informed consent. Three of 206 (1%) eligible patients were not included due to clinician refusal. Of 149 patients who were randomised, 76 were assigned to the pulmonary artery catheter group and 73 to the central venous catheter group. For the primary feasibility outcome, 147 patients (99%) received the allocated intervention. Data were complete for 144 (97%) patients. Median (IQR [range]) days alive and at home at 30 days was 23.7 (21.9-24.7 [7.0-26.0]) in the pulmonary artery catheter group and 22.9 (20.8-23.9 [8.6-25.8]) in the central venous catheter group. Acute kidney injury occurred in 26/76 (34%) patients in the pulmonary artery catheter group and 14/73 (19%) in the central venous catheter group. A randomised trial of pulmonary artery catheters compared with central venous catheters in low-risk cardiac surgery is feasible. Such a trial would address significant practice variability and inform international guidelines.

Atherosclerosis is characterized by lipid deposition, chronic inflammation, and apoptosis within the arterial wall, leading to plaque progression and instability. Current lipid-lowering therapies fail to fully address residual cardiovascular risk driven by local inflammation and cell death. Here, we report the development of uPA-functionalized, rapamycin-encapsulated dendrimer nanoparticles (G5PM-uPA/RA) that preferentially accumulate in urokinase plasminogen activator receptor (uPAR)-enriched atherosclerotic plaque, including macrophage- and apoptosis-rich lesion microenvironments. G5PM-uPA/RA was constructed by cross-linking reaction-enabled flash nanoprecipitation in a custom-made multi-inlet vortex mixer, followed by thiol-maleimide conjugation of uPA for uPAR-guided targeting. The nanoparticles demonstrated uniform morphology, favorable stability, and efficient rapamycin loading. In vitro, G5PM-uPA/RA exhibited enhanced macrophage uptake (1.3-fold than nontargeted form), sustained intracellular drug retention (2.2-fold than free drug), and effective suppression of inflammatory cytokine TNF-α release (-10%). In vivo biodistribution studies in Ldlr-/- mice confirmed accumulation of G5PM-uPA/RA in aortic lesions. Four weeks of G5PM-uPA/RA treatment in Ldlr-/- mice led to significant reduction in plaque burden (-52% in whole aorta, -41% in aortic root), necrotic core size (-68%), proinflammatory cytokines (-59% for TNF-α, -57% for IL-6), and apoptosis (-61%), while promoting fibrous cap thickening (+60%). Importantly, systemic toxicity was not observed. Collectively, these findings demonstrate that G5PM-uPA/RA offers an effective and safe strategy for inflammation modulation and plaque stabilization, providing a promising nanomedicine platform for atherosclerosis therapy.

The graft insertion technique is an effective choice for redo aortic root reconstruction in cases with extensive annular destruction. Nevertheless, its impact on postoperative left ventricular outflow tract (LVOT) geometry and flow dynamics has not been investigated in detail. A 69-year-old woman who underwent aortic valve replacement for infective endocarditis developed prosthetic valve dehiscence with paravalvular leakage and a large aortic root pseudoaneurysm after 4 months. Because the native annulus was completely destroyed, redo aortic root replacement using the Bentall procedure with the graft insertion technique was performed. Intraoperative examination revealed no macroscopic evidence of active infection but raised concerns regarding potential LVOT narrowing after the insertion of the inverted graft. Postoperative contrast-enhanced computed tomography demonstrated significant LVOT narrowing, with a minimal diameter of 14mm, despite the implantation of a 19-mm bioprosthetic valve. Moreover, four-dimensional flow (4D-flow) magnetic resonance imaging (MRI) revealed accelerated systolic flow at the narrowed LVOT, indicating functional LVOT stenosis. This case emphasizes an important pitfall of the graft insertion technique-postoperative LVOT narrowing caused by the intraventricular portion of the inverted graft. Postoperative morphological and hemodynamic evaluation using advanced imaging modalities, including 4D-flow MRI, may be required to ensure the safety of this technique in complex aortic root reconstruction.

This review summarizes current knowledge on Loeys-Dietz syndrome (LDS), including its genetic basis, multisystem manifestations, diagnosis, surveillance, and management. It also highlights key evidence gaps in risk stratification, medical therapy, imaging surveillance, surgical thresholds, and care of pregnant and pediatric patients. Although understanding of the genetic basis and clinical spectrum of LDS has improved, LDS-specific evidence remains limited. LDS is increasingly recognized as a multisystem disorder with aggressive aortic disease, extra-aortic vascular involvement, skeletal, craniofacial, allergic, gastrointestinal, and neurodevelopmental manifestations. Current recommendations are largely based on expert consensus and experience with related connective tissue disorders. Most available research focuses on the aortic root and ascending aorta, with less evidence guiding management of peripheral vascular disease. LDS requires early diagnosis, individualized risk assessment, and multidisciplinary longitudinal care supported by genetic evaluation, biomarker-based approaches, multimodality imaging, and structured surveillance. Future research should focus on multicenter registries, genotype-phenotype correlations, biomarker validation, advanced imaging, and LDS-specific therapeutic studies to develop evidence-based guidelines and improve long-term outcomes.

Endothelial dysfunction is an early event in atherosclerosis development and is centrally linked with insufficient endothelial NO production. However, chronically increased NO levels, including NO from other cellular sources, may induce endothelial dysfunction. Here, we studied how chronically elevated NO production from erythrocytes, achieved by genetic deletion of ARG1 (arginase-1), impacts smooth muscle cell (SMC) lipid accumulation and atherosclerosis progression. Primary aortic SMCs from mice lacking ARG1 in red blood cell (RBC.ARG1-knockout [KO]) were subjected to RNA-sequencing, lipidomic, metabolic, and molecular analyses; atherosclerosis burden was quantified en face and at the aortic root. Increased lipid droplet formation in SMCs from RBC.ARG1-KO mice was observed using brightfield and electron microscopy and confirmed by Oil Red O and boron-dipyrromethene lipid dye staining. RNA sequencing revealed the simultaneous overexpression of genes regulating lipid uptake (Cd36), catabolism (Cpt1a), and de novo lipogenesis (Acaca, Fasn [Fatty acid synthase]) in RBC.ARG1-KO SMCs, and inhibiting fatty acid translocase (CD36), ACC (acetyl-CoA [coenzyme A] carboxylase), or fatty acid synthase prevented the lipid accumulation in RBC.ARG1-KO SMCs. Increased expression of CD36 downstream of NO and overactivated sGC (soluble guanylyl cyclase)-cyclic guanosine monophosphate signaling was identified as a mediator of increased lipid uptake in RBC.ARG1-KO SMCs. Loss of PDE (phosphodiesterase) 2A, coupling cyclic guanosine monophosphate with cyclic adenosine monophosphate and PKA (protein kinase A) activation, was also observed, resulting in AMPK (5' AMP-activated protein kinase) inhibition, thus unlocking acetyl-CoA carboxylase, catalyzing the rate-limiting step in fatty acid synthesis. Inhibiting PDE2A recapitulated the RBC.ARG1-KO SMC phenotype, while inhibiting PKA or ATP generation from cyclic adenosine monophosphate abrogated the lipid droplet accumulation in RBC.ARG1-KO SMCs. Increased Oil Red O-positive aortic atherosclerosis burden in hypercholesterolemic apolipoprotein E-deficient RBC.ARG1-KO mice was confirmed by histology and elevated levels of polyunsaturated long-chain cholesterol esters in aortic atheroma by mass spectrometry lipidomics. Our findings show the importance of erythrocyte-derived NO for metabolically reprogramming SMCs toward increased fatty acid uptake and lipogenesis, and identify PDE2A as a molecular switch linking chronically activated NO signaling with lipid accumulation and atheroma progression.

Alcohol intake reprograms hepatic immune-metabolic circuits to exacerbate murine atherosclerosis and human cardiovascular risk.

Background Endovascular repair is an established option for symptomatic carotid artery dissection, particularly when hemodynamic compromise or embolic risk persists. In patients undergoing repair for acute type A aortic dissection (ATAAD), conventional transfemoral or transradial access may be prohibitive because of altered arch anatomy after graft reconstruction and stent-grafting. We report a postoperative left common carotid artery (CCA) dissection with focal aneurysmal dilatation and cerebral malperfusion following ATAAD repair. The lesion was treated using a hybrid strategy: direct cervical exposure for controlled retrograde transcarotid access and overlapping stent reconstruction. Case description A 48-year-old man presented with acute chest and back pain and was diagnosed with ATAAD. He underwent composite aortic repair including aortic root reconstruction, ascending and arch replacement, and descending aortic stent-grafting. Twenty-six hours postoperatively, he developed severe right-sided hemiparesis in the intensive care unit. Computed tomography angiography (CTA) showed near-occlusion of the mid-left CCA and delayed distal opacification. Given unfavorable transfemoral catheterization, emergent surgical cervical exposure enabled retrograde transcarotid sheath placement and deployment of three overlapping self-expanding stents. Final angiography demonstrated complete reperfusion (modified Thrombolysis in Cerebral Infarction, mTICI, grade 3) without intracranial distal embolization. Neurological recovery was favorable, with sustained stent patency and functional independence at follow-up. Conclusion Hybrid open retrograde transcarotid access may be considered a salvage option for postoperative CCA dissection after ATAAD repair when transfemoral access is prohibitive.

The impact of FBN1 variant types on pregnancy-related aortic dissection in women with Marfan syndrome.

As the prevalence and technological advancements of minimally invasive heart surgery continue to increase, aortic valve replacement(AVR) via right anterolateral mini-thoracotomy (RAMT) has matured, however, problems associated with Wheat's procedure (replacement of the ascending aorta(AAR) concomitant AVR) via RAMT approach have not been reported. The objective of this study was to compare the surgical quality, postoperative outcomes, and patient safety in patients undergoing Wheat's procedure via Full sternotomy (FS) versus RAMT. A retrospective analysis was conducted on the clinical data of 163 patients who underwent Wheat procedure between January 2022 and December 2024. Out of the 163 patients, 59 underwent the Wheat procedure via a right anterior minimally invasive incision. After 1:1 propensity score matching, by comparing various intraoperative and postoperative indicators, the outcomes of patients undergoing RAMT and FS were compared. Propensity scores identified 43 patients per group with similar baseline profiles. The results from the propensity-matched cohort are as follows. Although patients in RAMT group had longer cardiopulmonary bypass (RAMT 167 ± 57 vs FS 141 ± 40min; P = 0.04) and cross-clamp (RAMT 128 ± 39 vs FS 110 ± 29min; P = 0.04) time, they experienced reduced intraoperative blood loss (RAMT 317 ± 147 vs FS 456 ± 229ml; P = 0.005). No patients in the RAMT group required intraoperative conversion to Full sternotomy. There was no statistically difference in the in-hospital mortality between the two groups (0% and 0% in RAMT and FS, respectively). RAMT was correlated with a reduced incidence of postoperative atrial fibrillation (RAMT 3 [7.0%] vs FS 13 [23.3%]; P = 0.04). Receiving RAMT can lead to a reduction in postoperative NRS pain scores and an earlier discharge for patients. RAMT not only enables shorter incisions (RAMT 6.0cm vs FS 15.2cm; P < 0.001) but also has no impact on the size or type of the artificial valve or vessel implanted, thereby ensuring that the surgical effection is non-inferior to the FS group. In the Wheat procedure, the perioperative outcomes of RAMT closely resemble those of full sternotomy, and may be transferred in the field of cardiac surgery.

ABSTRACTBackground and AimsAortic regurgitation (AR) is associated with characteristic changes in aortic root geometry. Data on detailed echocardiographic patterns of AR in Iranian cohorts remain limited. This study aimed to describe the echocardiographic and etiologic characteristics of patients with AR and to assess the associations between standard aortic root measurements—including the aortic annulus (AA), sinuses of Valsalva (SOV), sinotubular junction (STJ), and ascending aorta (ASC)—and AR severity.MethodsThis retrospective cross‐sectional study reviewed transthoracic echocardiography reports of patients diagnosed with AR (n = 445) between 2017 and 2023 at a tertiary center. All examinations were performed and interpreted by a single experienced cardiologist. Aortic root dimensions and left ventricular measurements were extracted. Associations with AR severity were examined using appropriate parametric or nonparametric tests based on distributional assessment. Ordinal regression analysis was used to evaluate the independent association of aortic root dimensions and indexed parameters with AR severity.ResultsGreater AA, SOV, STJ, and ASC diameters were associated with higher AR severity in unadjusted analyzes, with SOV demonstrating the strongest relationship. All variables, including ASC, STJ, SOV, AA, and STJ/BSA, were correlated with the severity of aortic regurgitation. In multivariable ordinal regression analysis, ascending aorta diameter and the STJ/AA ratio were independently associated with AR severity, whereas STJ diameter and the STJ/BSA ratio were not significant after adjustment. STJ diameter showed no correlation with age. Degenerative and rheumatic etiologies were the most common causes of AR.ConclusionAortic root dimensions were associated with AR severity, underscoring the role of aortic root geometry in disease expression. The STJ/AA ratio emerged as an independently associated geometric parameter in adjusted analyzes, while STJ/BSA did not retain significance. As this was a retrospective cross‐sectional analysis, findings reflect associations rather than causal relationships and require confirmation in prospective, standardized studies.