Concepts of Aortic Valve Repair

Aortic valve (AV) sparing and repair procedures are advantageous alternatives to valve replacement in patients with aortic aneurysm and/or aortic regurgitation. A successful sparing or repair strategy proceeds first from a clear understanding of the peculiar anatomy and function of the AV and of the possible mechanisms of valve dysfunction. The AV is a functional unit composed of the valve cusps and the functional aortic annulus (FAA). Lesion on any or more of these components can induce aortic insufficiency. A functional classification of aortic regurgitation identifies three main mechanisms of AV regurgitation although more than one type of lesion can coexist in a patient. The goal of AV repair is to restore a normal surface of coaptation by restoring normal geometry between the leaflets and the FAA, while preserving normal mobility of the AV cusps. We present in detail our preferred surgical techniques for valve-sparing root replacement (VSRR) and repair of the AV cusps in the context of tricuspid AV. Further, we discuss the peculiarities of the VSRR and repair techniques in the context of bicuspid AV including our preferred approach to the bicuspid aortic dilatation

Surgical Repair of the Bicuspid Aortic Valve: Predictors of Failure

Surgical strategies in patients with bicuspid aortic valve (BAV), aimed at either correcting valve dysfunction, managing the BAV-associated aortic dilatation, or both, are diverse. Aortic valve replacement (AVR), with or without replacement of the proximal aorta, has been shown to be both effective and reliable in treating patients with aortic root dilatation, improving their prognosis and quality of life. It nonetheless exposes the patients to a variety of prosthesis-related complications. Alternatively, valve repair and valve-sparing techniques have been developed and evolved over the past two decades from an anecdotal approach to a plausible alternative to AVR in selected patients. In this chapter, we will review and discuss the currently available data regarding BAV repair failure, with a focus on the identification of preoperative, intraoperative, and postoperative echocardiographic and anatomical features associated with repair failure