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General Thoracic and Cardiovascular Surgery

, Volume 67, Issue 1, pp 82–92 | Cite as

Valve-sparing aortic root surgery. CON: remodeling

  • Takashi KuniharaEmail author
SPECIAL EDITION Controversies in Surgery for Thoracic Aorta

Abstract

The two major valve-sparing root replacement procedures, aortic valve reimplantation (reimplantation) and aortic root remodeling (remodeling), have advantages and disadvantages, which are reviewed herein. The main advantage of reimplantation is the resulting annular support, and the disadvantages are the unfavorable hemodynamics and relatively long procedure time. The main advantages of remodeling are the physiological hemodynamics and decreased procedure time, and the disadvantage is the lack of annular support. With technical advances and modifications, however, the differences between these two procedures have narrowed. Application of a graft with sinuses for reimplantation improves the hemodynamics, and addition of annuloplasty to remodeling provides the necessary annular support. Nevertheless, remodeling has some advantages because less root dissection is required and the procedure time is shorter and hemodynamically favorable. Thus, remodeling may be the procedure of choice for high-risk patients (such as those with acute aortic dissection, of advanced age, with reduced ventricular function, or undergoing a concomitant operation). Remodeling may also be best for young athletes because of the hemodynamic advantage. Regardless of the advantages and disadvantages, both procedures provide excellent clinical results in terms of late valve durability. Surgeons should be familiar with both techniques and properly match patients to the appropriate treatment.

Keywords

Aortic root remodeling Aortic valve reimplantation Valve-preserving root replacement Aortic valve repair Annuloplasty 

Notes

Compliance with ethical standards

Conflict of interest

The author has declared no competing interest.

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Copyright information

© The Japanese Association for Thoracic Surgery 2017

Authors and Affiliations

  1. 1.The Cardiovascular InstituteTokyoJapan

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