**10. Evaluation of the standardized approach to aortic valve repair: CAVIAAR trial and registry (Conservative Aortic Valve surgery for aortic Insufficiency and Aneurysm of the Aortic Root)**

Few series have compared valve repair with composite valve and graft replacement (Bassano et al., 2001; De Oliveira et al., 2003; Karck et al., 2004; Patel et al., 2008; Volguina et al., 2009; Zehr et al., 2004). Conclusions remain controversial since they were often retrospective, based on selected patients (Marfan), and compare different operating time periods, techniques and learning curve periods. Overall, rates of thromboembolism, bleeding, and endocarditis after valve repair seem lower than those reported for prosthetic valves. A current prospective international registry just provided 30-day morbidity and mortality data and shows equivalent results after a composite valve replacement or a valvesparing procedure (despite various type of reimplantation) in a selected population of Marfan patients (National Marfans Foundation prospective aortic root replacement registry) (Volguina et al., 2009).

In order to evaluate the standardized approach of valve repair using the expansible aortic ring versus mechanical valve replacement, unselected population of patients with aortic root aneurysms (bicuspid and tricuspid valves) are currently enrolled in France in the ongoing prospective multicenter CAVIAAR trial (Conservative Aortic Valve surgery for aortic Insufficiency and Aneurysm of the Aortic Root), over the next 5 years. Aside from the trial, all patients operated according to the CAVIAAR technique outside France are enrolled in the prospective CAVIAAR registry.
