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Updated: Jun 11, 2026
14:14
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Evolving Redo Frame-Preserving Leaflet Resection: From Transcatheter to Surgical Aortic Valves
Brian J Solomon1, Andreas Sarantopoulos1,2, Travis Howard2
1Department of Cardiothoracic Surgery, NCH Heart Institute, NCH Healthcare System, Naples, Florida.
Annals of Thoracic Surgery Short Reports
|June 10, 2026
Summary
The novel Surgical Valve Preservation and Resection of Bioprosthetic Leaflets (SUPERB) technique offers a hybrid approach for failed surgical bioprostheses, reducing risks in redo aortic valve replacement.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Biomedical Engineering
Background:
- Redo aortic valve replacement after bioprostheses failure is high-risk due to friable tissue, pannus ingrowth, and potential root reconstruction.
- Existing techniques like Surgical Resection of Prosthetic Valve Leaflets Under Direct Vision (SURPLUS) are effective for transcatheter valves.
- A novel evolution, Surgical Valve Preservation and Resection of Bioprosthetic Leaflets (SUPERB), is proposed for failed surgical bioprostheses.
Purpose of the Study:
- To describe and evaluate the novel SUPERB technique for redo aortic valve replacement in patients with failed surgical bioprostheses.
- To assess the feasibility and safety of preserving the aortic valve ring during leaflet excision.
- To compare outcomes with conventional explantation methods.
Main Methods:
- The SUPERB technique involves excising degenerated leaflets while preserving the supporting ring for direct vision balloon-expandable prosthesis deployment.
- Two high-risk patients with failed surgical bioprostheses underwent the SUPERB procedure.
- One patient with a failed transcatheter prosthesis underwent the SURPLUS procedure.
- Patients were unsuitable for valve-in-valve transcatheter replacement due to anatomical limitations.
Main Results:
- Successful leaflet excision and balloon-expandable valve deployment were achieved in all patients, with confirmed coronary patency.
- Operative times (cross-clamp and bypass) were minimized compared to conventional explantation.
- No annular disruption or root replacement was necessary, and prostheses remained functional at follow-up with no valvular regurgitation.
Conclusions:
- The SUPERB technique successfully adapts the SURPLUS concept for failed surgical bioprostheses, offering a hybrid alternative to complete explantation.
- This approach may reduce operative risks by shortening procedure times, preserving coronary access, and avoiding complex root reconstruction.
- Further multicenter evaluation is warranted to validate these findings.
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