ObjectiveValve-sparing root replacement (VSRR) requires a unique skill set. This study aims to examine the influence of surgeon’s procedural volume on outcomes of VSRR. MethodsThis is retrospective study of 1697 patients from two large, high-volume aortic centers who underwent aortic root replacement (ARR) from 2004 to 2021 and were potentially eligible for VSRR. Surgeons were classified as having performed <5 ARR or ≥5 ARR annually. Multivariable logistic regression was used to examine the independent association of surgeon volume and decision to perform VSRR. Inverse probability treatment weighting (IPTW) was used to match patients who were operated on by <5 ARR or ≥5 ARR surgeons and compare long term survival probability. Cumulative incidence curves with mortality as a competing risk were plotted to compare the rate of aortic valve reoperation. ResultsOf 1697 patients who met inclusion criteria, 944 patients underwent composite-valved conduit (CVC) ARR and 753 underwent VSRR. The median age of our cohort was 57 [45-66] years old and 268 (15.8%) were female. Aortic insufficiency (AI) was present in 1105 (65.1%) of patients and 200 (11.8%) of cases were a reoperation. Surgical indication was aneurysm in 1496 (88.2%) and dissection in 201 (11.8%) of patients. Among VSRR operations, 691/753 (92%) patients were operated on by ≥5 ARR surgeons and 62/753 (8%) patients were operated on by <5 ARR surgeons. In multivariable logistic regression, ≥5 ARR (OR: 3.33, 95% CI: 2.34-4.73, p <0.001) was associated with VSRR as a procedure of choice. Following IPTW, there was no significant difference in survival probability after VSRR between <5 ARR and ≥5 ARR surgeons (p = 0.59). There was also no significant difference in the rate of aortic valve reoperation (p = 0.6). ConclusionsIn the context of a high-volume aortic center, patients who undergo ARR are less likely to receive VSRR if operated on by a <5 ARR surgeon; however, VSRR may be safely performed by a <5 ARR surgeon.