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Conservative surgical treatment: The present and the future
Emmanuel Lansac1, Pichoy Danial2
1Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, 75013 Paris, France.
Archives of Cardiovascular Diseases
|February 3, 2026
Summary
Conservative aortic insufficiency management includes valve repair, the Ross procedure, and personalized external aortic root support (PEARS). These physiological strategies preserve native valve function, offering improved quality of life and long-term survival.
Area of Science:
- Cardiovascular Surgery
- Aortic Valve Disease
- Biomaterials Engineering
Background:
- Conservative management of aortic insufficiency aims to preserve native valve function and root dynamics.
- Current strategies include aortic valve repair, the Ross procedure, and personalized external aortic root support (PEARS).
- Aortic valve repair is recommended for dystrophic bicuspid/tricuspid aortic insufficiency, but adoption remains low.
Purpose of the Study:
- To review conservative surgical strategies for aortic insufficiency.
- To highlight the benefits and applications of aortic valve repair, the Ross procedure, and PEARS.
- To emphasize the shift towards individualized, tissue-preserving aortic valve surgery.
Main Methods:
- Review of current literature and European guidelines on aortic insufficiency management.
- Analysis of outcomes associated with aortic valve repair, Ross procedure, and PEARS.
- Discussion of emerging tissue-engineered implants.
Main Results:
- Aortic valve repair offers normal life expectancy and reduces prosthetic complications, with improved techniques leading to a Class I recommendation.
- The Ross procedure provides excellent quality of life and survival for selected young adults, with fewer complications than prosthetic valves.
- PEARS offers a preventive off-pump solution for aortic root aneurysm, stabilizing the root while preserving valve physiology.
Conclusions:
- Aortic valve repair, Ross procedure, and PEARS represent a paradigm shift in aortic valve surgery.
- These physiological techniques offer durable, individualized alternatives that preserve native tissue and restore normal valve dynamics.
- The goal is to achieve normal quality of life and long-term survival through tissue-preserving approaches.
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