Table 2. Potential causes and mitigating measures for autograft failure in patients with aortic regurgitation.

Potential causes	Mitigating measures
Aortic annular dilatation Aortic vs. pulmonary annular size mismatch Inadequate annular reduction technique	External circumferential ring annuloplasty Loose autologous jacket
Dilatation of autograft infundibular muscle	Autograft infundibular muscle trimming Subannular implantation
Autograft distortion at implantation	Ensure commissural symmetry
Sinotubular junction dilatation	Autograft trimming Proactive management of the mildly dilated ascending aorta (>36 mm)
Uncontrolled hypertension	Strict blood pressure control
Unrecognized familial aortopathy/connective tissue disorder	Careful screening