Reparative operations for insufficient cardiac valves constitute the surgical procedures of choice when pathoanatomies permit. At present, mitral and tricuspid repair techniques are well-established, but recent data also suggest that reconstruction of insufficient aortic valves may be associated with lower operative mortality, fewer valve-related complications, and improved survival. In an effort to increase adoption of aortic valve repair and to mitigate recurrent insufficiency, annuloplasty rings based on normal aortic root geometry have been developed to position in the inflow portion of the aortic annulus similar to mitral and tricuspid rings. This review will describe techniques for tri-leaflet and bicuspid geometric ring annuloplasty, and also will address leaflet reconstruction methods for the common leaflet pathologies. The application of a pathoanatomic approach to aortic insufficiency now permits the majority of aortic valves to be repaired with acceptable clinical outcomes.
The Kraske procedure minimizes exposure of mid-rectal lesions without the morbidity of a major laparotomy. However, it does carry a moderate complication rate and thus should be utilized selectively in managing patients with mid-rectal tumors not amenable to other treatment options.
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