ABSTRACT
The gold standard treatment for regurgitant aortic valve (AV) disease has traditionally been excision of the diseased valve and replacement with a biological or mechanical prosthesis. The placement of a prosthetic valve is far from the ideal solution as it is associated with numerous complications. Mechanical valves require life-long anticoagulation, and place patients at risk of haemorrhage, whereas biological valves undergo
structural degeneration and must eventually be replaced. Furthermore, all implanted valves put the patient at risk of prosthesis-related complications, including endocarditis, thromboembolism, and reoperation. In the case of the mitral valve, these concerns have become the impetus for the development of mitral valve repair. Reconstruction of the diseased valve using predominantly the patient’s own tissue obviates the need for anticoagulation and signi cantly reduces the incidence of prosthesis-related complications. Over the last three decades, these techniques
Introduction ................................................................................................................................................................. 45 Functional Anatomy of the Aortic Valve ..................................................................................................................... 46 Classi cation and Pathology ....................................................................................................................................... 46 Indications and Patient Selection ................................................................................................................................ 47 Operative Techniques .................................................................................................................................................. 48
Surgical Exposure and Lea et Assessment ............................................................................................................. 48 Techniques for Aortic Root Reconstruction (Type 1 Dysfunction) ........................................................................ 48
Type 1a ............................................................................................................................................................... 48 Type 1b ............................................................................................................................................................... 49 Type 1c ............................................................................................................................................................... 50
Techniques for Lea et Prolapse (Type 2 Dysfunction) .......................................................................................... 50 Free-margin Central Plication ............................................................................................................................ 50 Triangular Resection ........................................................................................................................................... 51 Free-margin Resuspension ................................................................................................................................. 52 Bicuspid Valves................................................................................................................................................... 52
Techniques for Lea et Restriction/Mixed Disease (Type 3 Dysfunction) .............................................................. 53 Intraoperative Echocardiographic Evaluation ............................................................................................................. 55 Outcomes by Classi cation ......................................................................................................................................... 55
Unselected Patient Populations ............................................................................................................................... 55 AVSRR and Type 1 Dysfunction ............................................................................................................................ 55 Type 2 Dysfunction ................................................................................................................................................. 56 Bicuspid Valves ....................................................................................................................................................... 56 Valve-related Events ............................................................................................................................................... 56
Conclusion .................................................................................................................................................................. 56 References ................................................................................................................................................................... 56
pioneered by Carpentier et al.1 have proven durable and currently represent the gold standard treatment for mitral regurgitation (MR).2
