Cusp repair techniques in bicuspid and tricuspid aortic valves

Abstract

Common aortic repair techniques for bicuspid and tricuspid aortic valves. CENTRAL MESSAGEVarious techniques are available for aortic cusp and valve repair. An individualized approach should be taken owing to the diverse valvular morphology and pathophysiology.See Commentaries on pages 117 and 119.

Has personalised surgery made another advancement in aortic root surgery?

“…This procedure was designed to preserve the aortic valve cusps in patients who have aortic root aneurysm with or without associated aortic regurgitation (AR) by replacing the aneurysmal root segment with an artificial aortic graft. Since the debut of the VSARR procedure, it has gained popularity in experienced surgeons and is an excellent choice for patients whose ARs are functional without calcification or fenestration and are mainly due to functional aortic annulus dilation 3 4. A variety of graft configurations with different graft geometries and neosinus construction techniques have also been described 3.…”

“…A variety of graft configurations with different graft geometries and neosinus construction techniques have also been described 3. In patients whose aortic valve cusps require further repair, standard aortic valve repair techniques can also be applied at the same time of VSARR 4…”

Commentary: Aortic regurgitation and aortic cusp repair: The devil is in the details

“…The average severity of aortic regurgitation is increasing, and the frequency of the need for cusp repair is increasing with it. 2 In this issue of the Journal , Zhu and Woo 3 provide an excellent and comprehensive review of cusp-repair techniques for bicuspid and tricuspid aortic valves. The authors describe a range of techniques from free margin plication to complex triangular resection with pericardial reconstruction, in which experience and expertise are key to achieving satisfactory results.…”

“…The cusps need to be pliable, they should not prolapse, and their coaptation surface needs to be adequate. The first step, as the authors eloquently state, 3 is enhancing the pliability and mobility of the cusps. Shaving off a modest amount of calcium can be acceptable, but there is a point at which replacing the valve may be the more durable option.…”

Commentary: That's all folks! But what should we really do to repair the aortic valve?

“…The article by Zhu and Woo 4 provides an overview of the knowledge gained through decades of commitment to achieving reliable aortic valve repair. The authors invite us to wholly understand the advancements that support the current state of the art.…”