Aortic valve repair

Recently, there has been a renewed interest with regard to surgical strategies for aortic valve preservation in the presence of isolated valve disease or concomitant aortic root disease, despite concerns having been raised about the mid/long-term durability of such repair techniques for the aortic valve. The aim of the present review is to analyze the currently available evidence about aortic valve repair strategies, for either bicuspid or tricuspid valves.

An improved understanding of the surgical anatomy and functional analysis of the aortic valve and root has allowed a systematic classification for the mechanisms of aortic valve insufficiency. Similarly, the use of dedicated instruments and devices has led to improved outcomes in terms of not only long-term survival but also freedom from reoperation.

Aortic valve repair, either as a stand-alone procedure or especially in combination with surgery of the root, is a well-tolerated and effective procedure with excellent outcomes at mid/long term. Recent efforts allowed the refinement of surgical techniques to develop a systematic approach to aortic valve repair, which implies a thorough understanding of the surgical anatomy, the functional causes of disease, and the available repair techniques along with their potential limitations. A specialized team including dedicated surgeons and cardiologists appears to be crucial to achieve durable and satisfactory outcomes following aortic valve repair.