eComment: Aortic root replacement using the reimplantation technique: tips and tricks

We would like to congratulate the authors on their interesting message [1]. Indeed, correct understanding of functional anatomy of the aortic root, critical assessment of the aortic valve cusp, as well as regular application of these techniques can provide excellent early and long-term results. The aortic valve-sparing reimplantation technique described by David and Feindel [2] is an established method for the surgical treatment of aortic regurgitation due to aortic root dilatation with preserved aortic leaflets. Recently, many reports have shown low operative risk and excellent freedom from thromboembolism and endocarditis with valve sparing procedure. Aortic valve function involves a complex interplay of the aortic root and cusps during the cardiac cycle. Evolution of the technique has shed light on the importance of a physiologic reconstruction of the aortic root which plays a key role in driving a correct function and durability of aortic cusps. In this report Boodhwani and colleagues [1], present their experience with 134 valve-sparing operations with low hospital mortality. The authors in the article focus on salient technical aspects. Special attention is given to the preparation of the graft tailored by the authors according to the features of an aortic root. It allows fixing the commissures along the same plane that prevents residual aortic insufficiency. We agree with the authors, that similar preparation of the graft as well as adequate aortic cusp repair can provide stable long-term results.