Abstract
‘Life is short, the art long, opportunity fleeting, experience treacherous, judgement difficult’ Hippocrates In this issue of the Journal, Schafers’ group from the University Hospital of Saarland, Germany has another important contribution on operative procedures to preserve the aortic valve in patients with aortic insufficiency (AI) [1]. From a cohort of 1094 patients who had conservative operations on the aortic valve at that institution, the authors examined the records of a cohort of 144 patients who had moderate or severe AI and dilated sinotubular junction (STJ). The operation consisted in adjusting the diameter of the STJ by replacement of the ascending aorta with a tubular Dacron graft of appropriate diameter and correcting aortic cusp prolapse, which was present in all but four patients. The cusp prolapse was repaired by plication of its central portion or by using a pericardial patch to reinforce or augment the cusp. In addition, reduction in the aorto-ventricular junction (AVJ) was performed by sub-commissural plication in 59 patients and by a circular suture with expanded polytetrafluoroethylene suture in 23. Most patients had congenital aortic valve disease (41% bicuspid and 19% unicuspid aortic valve). They analysed the entire cohort and the subgroups of patients with congenital aortic valve disease and with tricuspid aortic valve. As with any aortic valve preserving technique in the setting of
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