Updates in Aortic Valve Sparing Surgery

Abstract

For more than 90 years ago Aortic valve-sparing operations had been performed, but only recently surgeons have been able to match the aortic root disorder to the operative procedure correctly The development of aortic valve-sparing operations (re-implantation of the aortic valve and remodeling of the aortic root) expanded the surgical issues for treating patients with aortic root dilation caused by a variety of disorders. Young adults with aortic root aneurysms associated with genetic syndromes are ideal candidates for re-implantation of the aortic valve, and the long-term results have been excellent. Incompetent bicuspid aortic valves with dilated aortic annuli are also satisfactorily treated with the same type of operation. Older patients with ascending aortic aneurysm and aortic insufficiency secondary to dilated sino-tubular junction and a normal aortic annulus can be treated with remodeling of the aortic root or with re-implantation of the aortic valve. Annular dilation is often present in patients with incompetent BAV, correction of annular dilation is important, and re-implantation of the aortic valve may be the best option. There is a variety of techniques for Cusp Repair, considered as one of the valve-sparing techniques. Aortic valve-sparing surgery is performed to prevent hazards of Prosthetic valve implantation which is the most widely used therapeutic option for aortic regurgitation (AR), but complications associated with prosthetic valves, with an incidence of 3–5% patient/year, and the need for anticoagulation in mechanical valves, force us to consider aortic valve repair as an alternative to the prosthetic implant, especially in young people with many potential years of life for these complications. Aim of the work: This paper aims to have a description of surgical and dynamic anatomy of the aortic root, pathological changes that may affect it and important investigation for proper diagnosis and surgical planning. Highlights for aortic valve-sparing operations and their modification Review of Literature: Aortic valve-sparing (AVS) operations have become established alternatives to composite valve graft (CVG) procedures for patients with aortic root aneurysms and favorable aortic cusp morphology. The theoretical benefits of AVS procedures include avoiding the complications associated with prosthetic valves, specifically the risks of systemic thromboembolism and lifelong anticoagulation associated with mechanical valves. Summary: The development of aortic valve-sparing operations (re-implantation of the aortic valve and remodeling of the aortic root) expanded the surgical issues for treating patients with aortic root dilation caused by a variety of disorders.