Valve-sparing root replacement is indicated when the underlying mechanism of aortic regurgitation (AR) is enlargement of the aortic root. Furthermore, central plication according to measurement of the effective height (eH) is considered to be a standard form of treatment for leaflet prolapse. However, the aortic valve, unlike the mitral valve, has a relatively small tissue volume, and it is difficult to perform direct suturing of leaflet defects, such as fenestration, perforation, and retraction, and thus, a pericardial patch is mandatory for repair. These are still considered to be challenging conditions because the technique for patchplasty has not still been standardized. However, recently, Schäfers et al. and El Khoury et al. reported favorable long-term outcomes, and this has been recognized as one of the forms of aortic valvuloplasty [1, 2].
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