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Aortic valve-sparing operations: my perspectives

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Valve-sparing procedures have been established as a durable option for treatment of patients with aortic root pathology. Complex cases where aortic valve-sparing root replacement (VSRR) is applied require specific surgical techniques to ensure good outcomes. Herein, we review main concepts of VSRR and aortic valve repair. In addition, we provide three complex clinical scenarios: treatment of neo-aortic dilation after a Ross procedure, acute aortic insufficiency in a type A dissection, and chronic aortic insufficiency with a bicuspid aortic valve. Technical suggestions to achieve a safe and durable result are set forth.

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Authors and Affiliations

  1. Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC, USA

    Jennifer L. Perri & Edward P. Chen

Authors
  1. Jennifer L. Perri
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  2. Edward P. Chen
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Correspondence to Edward P. Chen.

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Ethical statement

No human subjects were utilized as study participants in this research. In cases where echocardiogram images or intra operative images were used, informed consent was obtained from the patients.

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Supplementary Information

For acute type A dissection, the intima and adventitia must be carefully preserved for valve sparing root replacement. At the level of the annulus the layers will be adherent. At the level of the commissures use tacking sutures to re-suspend all layers. (MP4 27237 kb)

Aortic insufficiency in a type A dissection can be readily addressed if the insufficiency is from acute prolapse and not longstanding cusp pathology. Use vacuum in the left ventricle and pass a suction instrument in and out of the valve to check leaflet coaptation. If the heights are equal and leaflets readily coapt, a valve sparing root replacement is feasible. (MP4 21131 kb)

Video 3

Lecture “Valve Sparing Procedure – My Perspectives” delivered by Dr. Edward Chen on November 18, 2022, at the 10th International Aortic Summit in Chennai, India. (DOCX 12 kb)

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Perri, J.L., Chen, E.P. Aortic valve-sparing operations: my perspectives. Indian J Thorac Cardiovasc Surg 39 (Suppl 2), 253–259 (2023). https://doi.org/10.1007/s12055-023-01587-4

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  • DOI: https://doi.org/10.1007/s12055-023-01587-4

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