Valve-sparing aortic root reconstruction

Abstract

The aortic valve-sparing reimplantation is a challenging procedure. Preservation of the native valve permits the maintenance of a proper hemodynamic and avoids the lifelong anticoagulation but the risk of recurrent aortic regurgitation remains its Achilles heel. The aim of this study is to evaluate the results of the aortic-valve sparing reimplantation technique presented both as single and multi -center experience. The impact of several variables on mortality and morbidity has been investigated. Moreover, the outcome of alternative techniques to treat the aortic root aneurysmal pathology, such as the Bentall and the Ross operation, has been explored. The following issues have been explored: - Early and mid-term results of the aortic valve reimplantation technique with reconstruction of the sinuses of Valsalva and compliance of the Valsalva graft pseudosinus at mid-term follow-up (Chapter 2-5). - Results of valve-sparing aortic root replacement in different settings including Marfan patients, bicuspid aortic valve and older patients (Chapter 6-8). - Impact of additional aortic cusp repair in patients with bicuspid and tricuspid aortic valve including long-term results (Chapter 9,10). - Outcome of the aortic root replacement with composite valve graft (Chapter 11,12). - Results of the Ross operation for the aortic root replacement (Chapter 13). Long-term results the aortic-valve sparing reimplantation show that this technique is extremely reliable, at least in presence of normal or nearly normal aortic cusps. Concerns regarding the durability of the aortic valve remain for patients who require extensive cusp repair. The composite valve graft procedure, according to the modified Bentall technique, is currently considered the gold standard for the treatment of the aortic root aneurysm or acute type I dissection in the presence of a irreparable aortic valve. The Ross operation represents an alternative treatment in young adults with non-reparable aortic valve with or without aortic root aneurysm