Aortic Valve Sparing Operations: A Review

Abstract

Aortic valve sparing operations were developed to preserve the native aortic valve during surgery for aortic root aneurysm as well as surgery for ascending aortic aneurysms with associated aortic insufficiency. There are basically two types of aortic valve sparing oprations: remodeling of the aortic root and reimplantation of the aortic valve. These operations have been performed for over two decades and the clinical outcomes have been excellent in experienced hands. Although remodeling of the aortic root is physiologically superior to reimplantation of the aortic valve, long-term follow-up suggests that the latter is associated with lower risk of developing aortic insufficiency. Failure of remodeling of the aortic root is often due to dilatation of the aortic annulus. Thus, this type of aortic valve sparing should be reserved for older patients with ascending aortic aneurysm and normal aortic annulus whereas reimplantation of the aortic valve is more appropriate for young patients with inherited disorders that cause aortic root aneurysms. This article summarizes the published experience with these two operations. They are no longer experimental procedures and should be part of the surgical armamentarium to treat patients with aortic root aneurysm and ascending aortic aneurysms with associated aortic insufficiency.

Midterm Results of David V Valve-Sparing Aortic Root Replacement in Acute Type A Aortic Dissection

“…Valve-sparing aortic root replacement (VSRR) was originally developed as an alternative surgical option to elective root replacement with a CVG for young patients with aortic root aneurysms [8]. VSRR is an attractive option for younger patients with type A aortic dissection because the disease is limited to the aortic sinus segments, thus leaving the native aortic valve cusps well preserved.…”

A Simple Device for Morphofunctional Evaluation During Aortic Valve-Sparing Surgery

“…In the hands of experienced surgeons, this surgical strategy achieves excellent results [1], but it exposes patients to the well-known problems associated with artificial valves [2]. On the other hand, when the aortic valve is structurally normal, valve-sparing root replacement is physiologically superior to the Bentall procedure and leads to lower valve-related complications [3].During the last decades, interest in these operations has increased considerably and outcomes have been widely investigated. Long-term results are critically dependent on perfect intraoperative restoration of valve anatomy and function [4], with many authors reporting excellent results especially when this target could be achieved [5].…”

“…In the hands of experienced surgeons, this surgical strategy achieves excellent results [1], but it exposes patients to the well-known problems associated with artificial valves [2]. On the other hand, when the aortic valve is structurally normal, valve-sparing root replacement is physiologically superior to the Bentall procedure and leads to lower valve-related complications [3].…”

“…Of note, residual aortic regurgitation has been advocated as the primary cause of early failure and need for reoperation in these patients [3]. Many authors have stressed that coaptation of aortic cusps has to be at the same level and above the nadir of the aortic annulus but below the level of the commissures [6].…”

Short-term results of aortic root reimplantation surgery

“…Из них можно выделить две основные методики: операция реимплантации аор-тального клапана в протез (операция David) и операция ремоделирования корня аорты (операция Yacoub). Пред-ложенная David методика используется уже в течение 20 лет и стала «золотым стандартом» и ориентиром в оцен-ке результатов как в ближайшем, так и в отдаленном пе-риоде наблюдения [1][2][3][4]. Ряд недостатков данной мето-дики -сложность и длительность, риск кровотечения, нарушение естественной биомеханики аортального кла-пана, риск травматизации створок, определенная непред-сказуемость -заставляют хирургов искать альтернативу [5][6][7].…”