Requested comment

Abstract

The concerns of Dr Gallo and associates regarding our technique of reconstruction of the aortic root with preservation of the aortic valve are valid. We also expressed concerns about it in our original article. 1David TE Feindel CM An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta.J THORAC CARDIOVASC SURG. 1992; 103: 617-622PubMed Google Scholar However, we have now preserved the aortic valve in more than 50 patients with aortic root aneurysm and we have had only one late failure, which occurred in a teenager with Marfan's syndrome. 2David TE, Feindel CM, Bos J. Repair of the aortic valve in patients with aortic insufficiency and aortic root aneurysm. J THORAC CARDIOVASC SURG [In press].Google Scholar The aortic valve function has remained stable up to 5 years in the remaining patients. Patient selection is probably the single most important factor in the outcome of any valve repair. In patients with aortic root aneurysm the aortic valve should be repaired only when the leaflets are normal. In a normal leaflet the length of its base is approximately 1.5 times longer than the length of its free margin. Next, if the patient has severe aortic valve insufficiency, the cause of valve dysfunction must be determined and the appropriate surgical technique used. When there is enlargement of both the aortoventricular junction and the sinotubular junction, an aortic annuloplasty and resuspension of the leaflets in a Dacron fabric tube is necessary (we refer to this technique as "reimplantation of the aortic valve"). When only the sinotubular junction is enlarged, supraannular reconstruction of the aortic root with or without reimplantation of the coronary arteries is done (we refer to this technique as "remodeling of the aortic root"). 2David TE, Feindel CM, Bos J. Repair of the aortic valve in patients with aortic insufficiency and aortic root aneurysm. J THORAC CARDIOVASC SURG [In press].Google Scholar By using these techniques in carefully selected patients we have been able to provide excellent clinical results in 51 of 53 patients operated on during the past 5 years. We remain carefully optimistic about these operative techniques. Observations such as those of Gallo and colleagues are important as surgeons introduce new operative techniques and they stress the necessity of continuing follow-up of these patients.