TY - JOUR
T1 - Aortic valve sparing surgery—patient selection and techniques
AU - Chauvette, Vincent
AU - Chamberland, Marie Ève
AU - Lefebvre, Laurence
AU - El-Hamamsy, Ismail
N1 - Publisher Copyright:
© Journal of Visualized Surgery. All rights reserved.
PY - 2021/1/20
Y1 - 2021/1/20
N2 - Aortic valve sparing root replacement (VSRR) is an attractive alternative to composite graft replacement in young patients with root aneurysms. The preservation of a native aortic valve provides more physiologic hemodynamics, avoids the complications associated with valve replacement and is associated with excellent long-term survival. However, this has to be weighed against the risk of reintervention due to valve failure in specific patients. Over the years, studies have shed light on various factors impacting VSRR durability. Specifically, patients’ characteristics, anatomical considerations and associated cardiac pathologies all have to be carefully analyzed. Furthermore, several technical aspects are crucial to ensure good long-term outcomes. Issues such as the presence of a bicuspid aortic valve, patients presenting with aortic disease and root aneurysms caused by heritable aortic disorders have been the subject of several studies. The outcomes and conclusions of these research contributions are reviewed and discussed. While the main discussion about VSRR technique used to be around the question of remodeling versus reimplantation, several recent studies have demonstrated that both techniques offer excellent outcomes. More importantly, the focus has shifted towards key technical aspects that may be achieved with both techniques: stabilization of the aortic annulus, creation of neo-sinuses of Valsalva, reduction and stabilization of the sino-tubular junction (STJ) and restoration of cusp geometry within the new aortic root. The aim of this article is to review these important clinical and technical considerations for planning VSRR.
AB - Aortic valve sparing root replacement (VSRR) is an attractive alternative to composite graft replacement in young patients with root aneurysms. The preservation of a native aortic valve provides more physiologic hemodynamics, avoids the complications associated with valve replacement and is associated with excellent long-term survival. However, this has to be weighed against the risk of reintervention due to valve failure in specific patients. Over the years, studies have shed light on various factors impacting VSRR durability. Specifically, patients’ characteristics, anatomical considerations and associated cardiac pathologies all have to be carefully analyzed. Furthermore, several technical aspects are crucial to ensure good long-term outcomes. Issues such as the presence of a bicuspid aortic valve, patients presenting with aortic disease and root aneurysms caused by heritable aortic disorders have been the subject of several studies. The outcomes and conclusions of these research contributions are reviewed and discussed. While the main discussion about VSRR technique used to be around the question of remodeling versus reimplantation, several recent studies have demonstrated that both techniques offer excellent outcomes. More importantly, the focus has shifted towards key technical aspects that may be achieved with both techniques: stabilization of the aortic annulus, creation of neo-sinuses of Valsalva, reduction and stabilization of the sino-tubular junction (STJ) and restoration of cusp geometry within the new aortic root. The aim of this article is to review these important clinical and technical considerations for planning VSRR.
KW - Aortic valve
KW - patient selection
KW - reimplantation
KW - remodeling
KW - valve sparing
UR - http://www.scopus.com/inward/record.url?scp=85147350431&partnerID=8YFLogxK
U2 - 10.21037/jovs.2020.02.05
DO - 10.21037/jovs.2020.02.05
M3 - Article
AN - SCOPUS:85147350431
SN - 2221-2965
VL - 7
JO - Journal of Visualized Surgery
JF - Journal of Visualized Surgery
M1 - 7
ER -