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Aortic valve repair: An evolving space in cardiac surgery

Mario Petrou

The surgical management of pure aortic regurgitation (AR) continues to evolve and the choice of operation depends on several factors including, the patho-anatomy of the aortic valve and root, patient characteristics and surgical expertise. The absence of an ideal biological or mechanical prosthesis historically stimulated the development of innovative valve-conserving techniques. Early pioneers invented the now established valve sparing aortic root replacement using the remodelling and re-implantation techniques [1,2] which focus on the geometrical correction of the aortic root and restoration of the normal alignment of the aortic valve apparatus to eliminate secondary AR. In the last 10 years or so however, some surgeons have pushed the envelope even further by introducing novel approaches to address primary AR using cusp repair techniques and associated annuloplasty [3-5]. This concept is analogous to more established mitral valve repair techniques which are now refined, reproducible and associated with excellent clinical outcomes. Indeed, it could be said that the current status of aortic valve repair surgery stands where mitral valve repair was some 35 years ago i.e. the preserve of only a hand-full of surgeons working in high-volume centres with a strong innovative ethos.