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Perspective: valve sparing root repair: tips and tricks

  • Ruggero De PaulisEmail author
  • Raffaele Scaffa
Review Article
  • 19 Downloads

Abstract

The remodeling and the reimplantation procedures were described more than 25 years ago with the aim of sparing otherwise normal aortic valves in the presence of a root aneurysm. Important achievements in this discipline have occurred over the past decade including development and refinement of valve preserving aortic root replacement techniques, development of a classification system for aortic insufficiency, and development of surgical approaches to cusp disease with varying cusp anatomy. The main advantage of the reimplantation is the resulting annular support, and the disadvantages are the unfavorable hemodynamics and relatively longer procedural time. Conversely, the main advantages of remodeling are the physiological hemodynamics and the shorter procedural time, and the disadvantage is the lack of annular support. With technical advances and modifications, however, the differences between these two procedures have narrowed. 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, the possibility of achieving favorable hemodynamics, and a much larger amount of data present in the literature on long-term results.

Keywords

Valve sparing Aortic valve Aortic root 

Notes

Compliance with ethical standards

Conflict of interest

Ruggero De Paulis receives royalties from Vascutek Terumo. Raffaele Scaffa declares that he has no conflicts of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg. 1993;105:435–8.Google Scholar
  2. 2.
    David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg. 1992;103:617–21.Google Scholar
  3. 3.
    Leyh RG, Schmidtke C, Sievers HH, Yacoub MH. Opening and closing characteristics of the aortic valve after different types of valve-preserving surgery. Circulation. 1999;100:2153–60.CrossRefGoogle Scholar
  4. 4.
    Grande-Allen KJ, Cochran RP, Reinhall PG, Kunzelman KS. Re-creation of sinus is important for sparing the aortic valve: a finite element study. J Thorac Cardiovasc Surg. 2000;119:753–63.CrossRefGoogle Scholar
  5. 5.
    Fukurawa K, Ohteki H, Cao ZL, et al. Evaluation of native valve-sparing aortic root reconstruction with direct imaging reimplantation or remodeling? Ann Thorac Surg. 2004;77:1636–41.Google Scholar
  6. 6.
    Lansac E, Di Centa I, Bonnet N, et al. Aortic prosthetic ring annuloplasty: a useful adjunct to a standardized aortic valve-sparing procedure? Eur J Cardiothorac Surg. 2006;29:537–44.CrossRefGoogle Scholar
  7. 7.
    Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg. 2006;132:436–8.CrossRefGoogle Scholar
  8. 8.
    David TE, Feindel CM, David CM, Manlhiot C. A quarter of a century of experience with aortic valve-sparing operations. J Thorac Cardiovasc Surg. 2014;148:872–9.CrossRefGoogle Scholar
  9. 9.
    de Kerchove L, Mosala Nezhad Z, Boodhwani M, El Khoury G. How to perform valve sparing reimplantation in a tricuspid aortic valve. Ann Cardiothorac Surg. 2013;2:105–12.Google Scholar
  10. 10.
    David TE, David CM, Manlhiot C, Colman J, Crean AM, Bradley T. Outcomes of aortic valve-sparing operations in Marfan syndrome. J Am Coll Cardiol. 2015;66:1445–53.CrossRefGoogle Scholar
  11. 11.
    De Paulis R, Chirichilli I, Scaffa R, et al. Long-term results of the valve reimplantation technique using a graft with sinuses. J Thorac Cardiovasc Surg. 2016;151:112–9.CrossRefGoogle Scholar
  12. 12.
    Lansac E, Di Centa I, Sleilaty G, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg. 2017;153:1033–42.CrossRefGoogle Scholar
  13. 13.
    Schneider U, Feldner SK, Hofmann C, et al. Two decades of experience with root remodeling and valve repair for bicuspid aortic valves. J Thorac Cardiovasc Surg. 2017;153:S65–71.CrossRefGoogle Scholar
  14. 14.
    Schneider U, Aicher D, Miura Y, Schäfers HJ. Suture annuloplasty in aortic valve repair. Ann Thorac Surg. 2016;101:783–5.CrossRefGoogle Scholar
  15. 15.
    Lansac E, Di Centa I, Raoux F, et al. An expansible aortic ring for a physiological approach to conservative aortic valve surgery. J Thorac Cardiovasc Surg. 2009;138:718–24.CrossRefGoogle Scholar
  16. 16.
    Fattouch K, Sampognaro R, Speziale G, Ruvolo G. New technique for aortic valve functional annulus reshaping using a handmade prosthetic ring. Ann Thorac Surg. 2011;91:1154–8.CrossRefGoogle Scholar
  17. 17.
    Miller DC. Rationale and results of the Stanford modification of the David V reimplantation technique for valve-sparing aortic root replacement. J Thorac Cardiovasc Surg. 2015;149:112–4.CrossRefGoogle Scholar
  18. 18.
    De Paulis R, De Matteis GM, Nardi P, Scaffa R, Colella DF, Chiarello L. A new aortic Dacron conduit for surgical treatment of aortic root pathology. Ital Heart J. 2000;1:457–63.Google Scholar

Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2018

Authors and Affiliations

  1. 1.Department of Cardiac SurgeryEuropean HospitalRomeItaly

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