Aortic root surgery: from valve sparing to 'spare and plasty'.


In the last decade, the aortic root has been receiving increasing attention with the aim of preserving as much as possible a proper function of the natural aortic valve on one hand, and to stabilise its diameter to avoid any further progressive root dilatation on the other hand. In this issue of the journal, two aspects have been raised over the optimal treatment of the pathology of the aortic root [1,2]. The first one [1] concerns the possibility of widening the indication for valve-sparing procedure and, more specifically, offering a valve-sparing operation also to patients with a severe aortic regurgitation (AR) or to patients with a bicuspid aortic valve (BAV). The second one [2], given for granted the sparing of a BAV, explores the optimal surgical approach to stabilise the aortic root. These are, indeed, two faces of the same coin: can we somehow standardise our approach to a valve-sparing procedure for various anatomical situations, and make it available to a larger number of patients with more advanced or complex pathologies? It is probably possible, but it will doubtless require increased skill and, at the same time, will expose the surgeon to an increased number of failures and disappointments. In fact, in the case of a functioning or less than severely incompetent tricuspid aortic valve (TAV), it is well established that a valve-sparing operation can guarantee stable and long-term results [3]. This has been proved especially true in the case of the reimplantation type of valve-sparing procedure where the issue of annulus stabilisation is well addressed [3—5]. Nonetheless, a remodelling procedure that is, by definition, a more physiological anatomical reconstruction, might probably work well when the annulus is not dilated. However, whether the presence of non-compliant Dacron graft could induce a progressive annular dilatation even in a non-dilated annulus is still a matter of debate. It is, therefore, obvious that if we begin with a normally functioning tricuspid valve and the surgical procedure is only aimed at the root pathology, the results are more predictable and will better hold the test of time. Early or late failure in terms of re-operation or residual aortic valve regurgitation could probably be ascribed only to an intra-operative alteration of leaflet

DOI: 10.1016/j.ejcts.2010.09.035

Cite this paper

@article{Paulis2010AorticRS, title={Aortic root surgery: from valve sparing to 'spare and plasty'.}, author={Ruggero de Paulis}, journal={European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery}, year={2010}, volume={38 5}, pages={513-4} }