ABSTRACT
Tuffier is believed to have performed the first aortic valve repair in a patient with aortic stenosis in 1913. The operation consisted of digital invagination of the dilated ascending aorta wall and “dilatation” of the stenotic valve. Following the popularization of Gibbon’s and Lillehei’s methods for extracorporeal circulation in the mid-1950s, aortic insufficiency, which had largely defied closed efforts at correction, was somewhat more responsive to open plastic procedures. Since then, a variety of reports have been published on repair of aortic insufficiency by suturing two adjacent cusps together to correct prolapse or by excising the non-coronary cusp and its aortic sinus and narrowing of the aortic root and proximal ascending aorta, thus converting the aortic valve into a bicuspid valve. Because only a few patients could have aortic valve repair, various autologous tissues, such as pericardium, aortic wall segments, full-thickness left atrial wall, central tendon of the diaphragm, peritoneum, and fascia lata, were used for reconstruction of heart valves. With the development of prosthetic heart valves, aortic valve repair became a rare operation and was largely limited to pediatric cases of subaortic ventricular septal defect and aortic insufficiency due to prolapse of the right cusp. With the development of transesophageal Doppler echocardiography and better understanding of the functional anatomy of the aortic valve, interest in aortic valve repair was renewed.
