An aortic ring: From physiologic reconstruction of the root to a standardized approach for aortic valve repair

Abstract

A standardized and physiologic approach to aortic valve repair, considering both the aorta (root remodeling) and the valve (resuspension of the cusp effective height and subvalvular ring annuloplasty) improved the preliminary results and might affect their long-term durability. The ongoing Conservative Aortic Valve Surgery for Aortic Insufficiency and Aneurysm of the Aortic Root (CAVIAAR) trial will compare this strategy to mechanical valve replacement.

Repair of the Regurgitant Bicuspid or Tricuspid Aortic Valve

“…32 A new sinus prosthesis that can probably maintain physiological root anatomy is available 33 ; widespread use can be expected once conclusive midterm and long-term results on functional valve outcome are available. In addition, an aortic annuloplasty ring for annular downsizing and stabilization 34,35 may prove helpful in numerous reconstructive approaches to treat the leaking aortic valve, and its use also may increase in the future. In vitro evaluation of this device has delivered promising initial results.…”

Long-term results of the valve reimplantation technique using a graft with sinuses

“…It is of note that various techniques of annuloplasty have been recently added to the standard remodeling to prevent this potential long-term drawback of this technique. 2 The reimplantation technique as originally described by David and Feindel 3 stabilizes the annulus but does not achieve a correct root reconstruction considering that the sinuses of Valsalva are abolished. For this reason, through the years, a series of technical modifications have been added to the original technique to achieve a better reconstruction of the sinuses.…”

The Influence of the Aortic Root Geometry on Flow Characteristics of a Prosthetic Heart Valve

“…In reality, the dilation of the aortic base diameter is an important factor which is associated in particular with aortic valve insufficiency [38] and can lead to progressive valvular incompetence, rupture, and dissection in adults, as well as in children [39], A highly complicated two valve-sparing pro cedures, that is remodeling of the aortic root and reimplantation of the aortic valve so that root can be accurately reconstructed, are aimed to reduce the diameter of the dilated aortic root and allow the valve to function properly [40,41]. First, there are several simplifying assumptions that are not present in the truly diseased conditions.…”