Surgery for Aortic Regurgitation

Abstract

This review explores the surgical treatment options for aortic regurgitation. Aortic valve-sparing operations and total aortic root replacement with valved conduits are established standard procedures. Alterations in any component of the aortic root can lead to aortic regurgitation. Today, the primary valve-sparing techniques are remodelling (Yacoub procedure) and reimplantation (David procedure). Severely calcified aortic valves, cusps with retraction or multiple large fenestrations cannot be repaired. In such cases, the en bloc replacement of the aortic valve and the root with different types of composite valve grafts – known as the Bentall procedure – is a feasible option. The procedure in which the diseased aortic valve is replaced with the patient’s own pulmonary valve is known as the Ross procedure. Large-scale studies and meta-analyses confirm that aortic valve-sparing procedures provide excellent survival and freedom from reoperation, making them the best option for selected patients when performed in experienced centres.