Surgical treatment of aortic valve disease

The development of intraoperative transoesophageal echocardiography together with improved understanding of the functional anatomy of the aortic valve have allowed the design of several new conservative procedures, such as aortic valve-sparing operations, to treat patients with aortic root aneurysms or aortic insufficiency. The long-term results of these procedures have been excellent, and >90% of patients are free from reoperation on the aortic valve 10-15 years after surgery. Incompetent bicuspid aortic valves can also be repaired if the cusps are pliable and without calcification. Nevertheless, most patients with aortic valve disease, particularly those with aortic stenosis, need aortic valve replacement. Matching a patient to the type and size of prosthetic aortic valve is difficult, because of the limited durability of bioprosthetic valves and the need for lifelong anticoagulation with mechanical valves. Prosthesis-patient mismatch might not affect survival in most patients, but is a determinant of prognosis in patients with impaired ventricular function. Young adults with aortic stenosis, particularly women during childbearing years, can be treated with the Ross procedure. Finally, poor candidates for surgery who have aortic stenosis can now be treated with catheter-based aortic valve implantation but, in this article, the current status of aortic valve surgery is reviewed.