Aortic Root Replacement : Should the valve be fixed or spared ?

Despite the frequency of aortic valve (AV) surgery, techniques for AV repair have been adopted more slowly by surgeons when compared to repair techniques for the mitral valve. Undoubtedly the fact that the majority of AV operations are performed to relieve stenosis explains higher rates of AV replacement and reduced opportunities for repair experience. However there is growing recognition that many patients with isolated aortic regurgitation (AR), that is AR without significant stenosis, may be approached with repair techniques. Furthermore, it has been shown that AV repair offers durable results, relatively comparable to valve replacement, without prosthesis-associated complications. This is true for patients with both trileaflet and bicuspid valves. The realization that the integrity of the entire aortic root (which includes the ventriculo-aortic junction [aortic annulus], the valve, the sinuses, and sinotubular junction) is important in determining the outcome following repair has also undoubtedly contributed to repair success.