General Thoracic and Cardiovascular Surgery

, Volume 67, Issue 1, pp 77–81 | Cite as

PRO-CON debate: valve sparing aortic root surgery. PRO: reimplantation

  • Ruggero De Paulis
SPECIAL EDITION Controversies in Surgery for Thoracic Aorta


The remodeling and the reimplantation procedures were described more than 25 years ago with the aim of sparing, otherwise normal aortic valve in the presence of a root aneurysm. Because of its ability to reconstruct the sinuses of Valsalva, the remodeling procedure was considered to be more physiological than the reimplantation. However, because the remodeling lacked annular stabilization, the long-term stability of the procedure was questioned. However, through the years, both procedures have been significantly improved, so that is now possible to perform a reimplantation procedure with neo-sinuses reconstruction or a remodeling procedure with annular stabilization. In this way, both procedures can now guarantee an anatomical root reconstruction and an increased long-term durability. Today preference for a reimplantation procedure is based on the perception of a better reproducibility of the surgical procedure, an increased procedural safety due to the characteristic hemostatic feature of this surgical approach, and to a much larger amount of data present in the literature on long-term results.


Valve sparing Aortic root Aortic valve Great vessels 


Compliance with ethical standards

Conflict of interest

The author might have a potential conflict of interest: The author receives royalties from Vascutek Terumo in conjunction with the design of the Valsalva graft described in this article.


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Copyright information

© The Japanese Association for Thoracic Surgery 2017

Authors and Affiliations

  1. 1.Department of Cardiac SurgeryEuropean HospitalRomeItaly

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