Guo MH, Cole E, Fei LYN, et al. - In this study, the effect of pre-operative left ventricular (LV) dimension on the long-term outcome of aortic valve preservation surgery was explored. Researchers recruited a total of 256 patients who had undergone aortic valve preservation surgery at a single center between 2009 and 2019. Five years was the median follow-up. The primary endpoint included the development of > 1+ AI at 6-years and long-term mortality, freedom from >2+ AI, and freedom from aortic valve re-operation were considered as secondary endpoints. Predictors of aortic valve deterioration were identified by performing Cox-proportional hazard analysis. It was shown that the higher pre-operative indexed left ventricular end-systolic dimension ≥ 2 cm/m ² increases the risk of recurrent > 1+ AI following aortic valve preservation surgery. Future study in the appropriate operative threshold for AI may be warranted.