Aortic Valve Sparing Operation

A standard approach in the surgical treatment of severe aortic regurgitation and/or aortic root dilatation is Bentall procedure, it means replacement of the aortic valve and ascending aorta with a composite graft including mechanical or biological valve. The original technique described by Bentall and De Bono in 1968 (5). This is a „safe“ method with low mortality, but patients have to accept the disadvantages of lifelong anticoagulation and comercial valvular prosthesis, such as higher risk of tromboembolic complications, bleeding, endocarditis and also rapid degeneration of biological prosthesis (28). The alternative technique for the patients with aortic root dilatation and/or ascending aorta aneurysm and aortic valve incompetence, causing by outward displacement of the commissures is the aortic valve-sparing operation (24). The technique of aortic root remodeling first described by Sarsam and Yacoub and technique of aortic valve reimplantation first described by David and Feindel in 1993 (33,9). The both techniques preserve the native aortic valve and partialy dynamic native aortic valve annulus, which may have hemodynamic benefits over a rigid prosthetic valve stent. The major benefits are freedom from anticoagulation treatment, relative resistance to infection compared with prosthetic valves and maybe better resistance against the premature degenerative changes of the bioprosthesis (multifactorial etiology). A major drawback is the increased risk of early failure of reconstructed valve cause the valve incompetence and needing the early reoperation (24). Aortic valve sparing operations were developed to preserve native tricuspid aortic valve without gross structural defects and absence of severe cusp prolapse or assymetry (9). In recent years, surgeons gaining more and more experience and skills and indications were liberally expanded to include older and also younger patients, patients with bicuspid valves, aortic valves with cusp prolapse, Marfan patients, patients with acute type A dissection, endocarditis and reoperation (1,14,26,19,18). Future and longer follow up will show us the best solutions for each of these categories.