Aortic Valve Repair: State of the Art

Aortic valve repair has now been shown by long-term evidence to reduce valve-related mortality while restoring quality and life expectancy similar to the general population. However the rate of repair worldwide remains low (around 15%-20%), while 80% of regurgitant valves can be repaired. The commonest cause of aortic insufficiency (AI) in the western world is dystrophic AI with thin and pliable tricuspid, bicuspid, unicuspid, or quadricuspid valves. Three phenotypes of the aorta can be distinguished: dilated aortic root; dilated ascending aorta; and isolated AI. Characteristic lesions leading to dystrophic AI include: a dilated annulus > 25 mm, dilation of the sinotubular junction (STJ) and cusp prolapse. Sub- and supravalvular aortic annuloplasty (reduction of the annulus), restoring the ratio between annulus and STJ, as well as cusp effective height resuspension are all critical components of aortic valve repair and valve-sparing root surgery, helping to increase the surface of cusp coaptation and protecting the repair for long-term durability.