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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Cusp repair during aortic valve-sparing operation: technical aspects and impact on results
Fabrizio Settepani1, Antioco Cappai, Giuseppe M Raffa
1Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
Insights
Aortic valve-sparing surgery is safe, but cusp repair techniques require careful consideration. While results are encouraging, complex repairs should be performed at experienced centers.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair
Background:
- Aortic valve-sparing operations demonstrate safe mid-term and long-term outcomes.
- While graft implantation is established, aortic cusp repair techniques remain debated.
Purpose of the Study:
- To review literature on the necessity and techniques of aortic cusp repair during valve-sparing operations.
- To provide guidance on when and how to perform aortic cusp repair.
Main Methods:
- Literature search of PubMed using keywords related to aortic valve-sparing surgery and cusp repair.
- Inclusion of studies detailing cusp repair techniques in conjunction with valve-sparing aortic surgery.
Main Results:
- Bicuspid aortic valves necessitate repair more frequently than tricuspid valves.
- Repair techniques range from simple plication to complex triangular resection with patch repair.
- Cusp repair generally does not compromise mid-term or long-term valve competence.
Conclusions:
- Aortic cusp correction involves balancing undercorrection (prolapse) and overcorrection (restriction).
- Complex aortic valve repair alongside root replacement yields satisfactory results.
- These complex procedures are best suited for high-volume, experienced surgical centers.
Aims:
Aortic valve-sparing operations are nowadays considered safe and reliable procedures in terms of mid-term and long-term results. Although surgical techniques regarding the modality of grafts' implantation have been properly addressed, the modality of cusp repair, when needed, is still open to debate. We sought to review the literature to try to shed light on when the cusp repair is required and how it should be performed.
Methods:
We searched the PubMed database using the keywords aortic valve-sparing operation, aortic valve-sparing reimplantation, valve-sparing aortic root replacement, aortic valve repair, and aortic cusp repair. Only studies that included and described in detail the technique of cusp repairs in adjunct to aortic valve-sparing operation were considered.
Results:
Bicuspid aortic valve more often requires correction when compared with tricuspid valve. The range of the techniques varies from the 'simple' free margin plication to the more complex triangular resection with patch repair. Results in the literature seem to be encouraging, showing that, in most of the cases, cusp repair does not affect valve competence in the mid-term and long-term.
Conclusion:
Correction of the cusp is a delicate balance between undercorrection that could lead to residual prolapse and overcorrection that could lead to cusp restriction. Although complex repair of the aortic valve in addition to root replacement provided satisfactory results, it should be reserved for experienced centers with a large volume of patients.
