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From dynamic anatomy to conservative aortic valve surgery: the tale of the ring

  • Emmanuel Lansac
  • I. Di Centa

Abstract

Pure aortic insufficiency (AI) represents 9.5% of the surgical indications of valve surgery in western countries [53, 92]. Dilation of the aortic root and/ or cusp prolapse are the most common causes of AI, characterized by pliable cusps that are macroscopically close to normal [29, 70]. Until recently, valve replacement was the only surgical option for AI. However, none of the current valve substitutes are ideal options, since mechanical valves require life-long anticoagulation and bioprosthetic valves present the risk of reoperation. Inspired by mitral experience, reconstructive methods have been developed to treat AI, based on sparing or repairing the native aortic valve, while replacing or stabilizing the other components of the aortic root [17, 24, 116]. Recent progresses in aortic valve-sparing techniques mirrors the evolving understanding of the functional anatomy of the aortic root complex which includes the cusps, the crown-shaped aortic annulus, the interleaflet triangles, and the sinuses of Valsalva [72, 77]. All “share a dynamic coordinated behaviour, which can be partially or completely restored in various repair or replacement procedures of the aortic root” [77]. Although mid-term results are encouraging, heterogeneousness of current valve-sparing techniques limits the widespread adoption of these procedures and reinforces the need for standardization and rigourous evaluation.

Keywords

Aortic Valve Aortic Root Bicuspid Aortic Valve Aortic Root Replacement Aortic Valve Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Emmanuel Lansac
    • 1
  • I. Di Centa
  1. 1.Service de chirurgie cardiovasculaireHôpital FochSuresnesFrance

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