Aortic Valve-Sparing Operations: Early and Midterm Results

Abstract

Aortic valve-sparing operations showed excellent results in patients electively operated on for aortic root ectasia, and the results in acute aortic dissection were very disappointing. The Gelweave Valsalva prosthesis demonstrated ease of implantability and good reproduction of the pseuodosinuses. Long-term follow-up is necessary to determine if this graft will enhance the function and increase the durability of the aortic valve.

Correction of leaflet prolapse extends the spectrum of patients suitable for valve-sparing aortic root replacement

“…Compared with other series [2,5,9,10,13,14], we have been more aggressive in pursuing valve preservation. Despite this, the addition of leaflet prolapse correction yielded encouraging durability with survival, freedom from significant AR and freedom from AVR being comparable with earlier studies, which reported rates between 88% and 99% [2,10,[13][14][15].…”

Clinical and Echocardiographic Outcomes After Aortic Valve Repair Surgery

“…Valve-sparing aortic root replacement is clearly beneficial for annulus stabilization. [6][7][8][9][10][11]13,14,16,19,21 However, valve-sparing root replacement may be solely sufficient only in patients with secondary AI, while patients with AV cusp abnormalities, with or without annular dilatation, would need a more complex and challenging repair. The surgeon performing AV repair must be concerned with all components of the complex anatomy of the AV and aortic root, and it should be analyzed in detail preoperatively.…”

“…Aortic valve (AV) repair provides alternative treatment for prosthetic AV replacement in carefully selected patients with aortic insufficiency (AI), and include annuloplasty, 1–3 resection of the cusps, cusp plication, 4,5 cusp augmentation using autologous pericardial patch, and aortic root replacement by the aortic valve sparing surgery when the root is dilated and the regurgitation is stringent by annular dilatation. 6–11…”

“…Aortic valve (AV) repair provides alternative treatment for prosthetic AV replacement in carefully selected patients with aortic insufficiency (AI), and include annuloplasty, [1][2][3] resection of the cusps, cusp plication, 4,5 cusp augmentation using autologous pericardial patch, and aortic root replacement by the aortic valve sparing surgery when the root is dilated and the regurgitation is stringent by annular dilatation. [6][7][8][9][10][11] These days, AV repair is done mostly in young patients, where bioprosthetic valves show a high structural failure rate, and mechanical valves show high rates of anticoagulation-related hemorrhage and thromboembolic events because of lifelong exposure time. 12 While in the past, AV repair was used mostly for patients with predominant annular dilatation as the etiology for the AI, 9 during the past decade, this procedure was expanded to include patients with anatomic valve abnormalities, such as bicuspid AV (BAV), unicuspid AV (UAV), and also deformed or partially calcified tricuspid AV (TAV).…”