Valve-sparing aortic root reimplantation and cusp repair in bicuspid aortic valve: with aortic insufficiency and root aneurysm.

Abstract

The text of this manuscript describes the surgical techniques demonstrated in our video, “Valve-sparing aortic root reimplantation in bicuspid aortic valve: with aortic insufficiency (AI) and root aneurysm” (Video 1). Video 1 Valve-sparing aortic root reimplantation and cusp repair in bicuspid aortic valve: with aortic insufficiency and root aneurysm This video shows our approach to valve-sparing aortic root reimplantation in bicuspid aortic valve (BAV) presenting with proximal dilation and eccentric aortic valve insufficiency. Understanding the aortic insufficiency classification system as conceived by the Brussels group under the direction of Gebrine El Khoury and published by Boodhwani et al. is important. This video is our approach to the combination type Ib/II BAV. This is the most common presentation and represents aortic root dilation with cusp prolapse. The anatomy of the classically repairable type Ib/II BAV is characterized by lack of signification leaflet calcification, presence of eccentric AI, and dilated proximal aorta with sinotubular junction (STJ) effacement. Note that the actual sinus segment is mildly dilated only. The main concepts of bicuspid aortic valve repair and root reimplantation are as follows: (I) leaflet/cusp free margin equalization, (II) annular stabilization and annular reduction, (III) raphe release (IV) optimization of the leaflet coaptation height to ensure elevation of this height above the annular plane, and (V) root reimplantation and coronary button reconstruction.