Aortic valve-sparing operations in patients with ascending aortic aneurysms

Composite replacement of the aortic valve and ascending aorta was the standard treatment for patients with aortic insufficiency and aortic root aneurysm. However, it has been pointed out that the aortic valve leaflets are normal or near normal in almost one half of the patients who undergo surgery for aortic root aneurysms. It is now possible to accurately determine the quality of the aortic valve leaflets using transesophageal multiplane echocardiography, and with current knowledge of the functional anatomy of the aortic root, it is feasible to reconstruct the aortic root and preserve the aortic valve leaflets in these patients. There are various aortic valve-sparing procedures depending on the mechanism of aortic insufficiency and the pathology of the aortic root. Although these operations are now performed in many cardiac centers, long-term results are not yet available. Aortic valve-sparing operations have been performed in 97 patients in our institution since 1988; the clinical results have been excellent and the valve repair remains stable for up to 8 years of follow-up. These results justify the continued use of these operative procedures.