“…Effacement of the sinuses and dilation of the root can interfere with this physiology contributing to aortic insufficiency. Dilation of the sinotubular junction (STJ) can also pull on the commissures of the aortic valve leaflets creating a distance between their free margin, leading to poor coaptation and central regurgitation ( 56 ). Though, at times, there is an isolated dilated ascending aorta without involvement of the root—which can also contribute to poor aortic valve function—, frequently there is involvement of the root.…”
Section: Surgical Management Of Aortic Insufficiencymentioning
Aortic insufficiency (AI) is a valvular disease with increasing prevalence in older patients. The modern era provides numerous options for the management of AI which is explored here. Traditional interventions included aortic valve replacement with either mechanical or bioprosthetic aortic valves. While the former is known for its durability, it has grown out of favor due to the potential complications of anticoagulation. The preference for bioprosthetic valves is thus on the rise, especially with the advancements of transcatheter technology and the use of valve-in-valve therapy. Surgical options are also no longer limited to replacement but include complex techniques such as those required for aortic valve repair, Ozaki neocuspidization, Ross procedure and valve-sparring aortic root repair. Transcatheter options for the management of AI are not commercially available currently; however, preliminary data from ad-hoc trials, showed promising results and potential use of transcatheter technology in a variety of patients with pure AI.
“…Effacement of the sinuses and dilation of the root can interfere with this physiology contributing to aortic insufficiency. Dilation of the sinotubular junction (STJ) can also pull on the commissures of the aortic valve leaflets creating a distance between their free margin, leading to poor coaptation and central regurgitation ( 56 ). Though, at times, there is an isolated dilated ascending aorta without involvement of the root—which can also contribute to poor aortic valve function—, frequently there is involvement of the root.…”
Section: Surgical Management Of Aortic Insufficiencymentioning
Aortic insufficiency (AI) is a valvular disease with increasing prevalence in older patients. The modern era provides numerous options for the management of AI which is explored here. Traditional interventions included aortic valve replacement with either mechanical or bioprosthetic aortic valves. While the former is known for its durability, it has grown out of favor due to the potential complications of anticoagulation. The preference for bioprosthetic valves is thus on the rise, especially with the advancements of transcatheter technology and the use of valve-in-valve therapy. Surgical options are also no longer limited to replacement but include complex techniques such as those required for aortic valve repair, Ozaki neocuspidization, Ross procedure and valve-sparring aortic root repair. Transcatheter options for the management of AI are not commercially available currently; however, preliminary data from ad-hoc trials, showed promising results and potential use of transcatheter technology in a variety of patients with pure AI.
“…This embraces concepts of VAJ remodeling and prosthesis trimming during reimplantation ( Figure 2 ) and complete circular annuloplasty, both internally and externally,popularized by Nawaytou and colleagues 9 and promoted by G.El Khoury 9 and T. David. 11 Figure 1 Concept of tailored external annuloplasty with anatomic inflow line. Figure 2 Tailored graft during reimplantation- author's technique.…”
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