Repair of the Regurgitant Bicuspid or Tricuspid Aortic Valve

The treatment of severe aortic valve regurgitation (AR) has been moving ahead quickly and has undergone a fundamental transition over the past few decades. Mechanical or bioprosthetic aortic valve replacement has been the standard of care for many years for most types of AR. Although still restricted to patients with well-defined pathological aortic valve and root anatomy, the number of accepted indications for reconstructive aortic valve surgery is growing.The cusp tissue, aortic annulus, tissue of the sinus of Valsalva, commissures, subcommissural tissue, and sinotubular junction constitute the functional unit of what is generally called the aortic root. Reconstructive surgery for severe aortic valve insufficiency today includes a wide variety of procedures on all of those components, from simple cusp plication to complex valve-sparing aortic root replacement (V-SARR). It is ultimately aimed not only at improving symptoms of congestive heart failure and increasing life expectancy but also at giving the patient a chance to live a normal life because it renders lifelong anticoagulation unnecessary. V-SARR procedures have recently been discussed not only as adequate correction for aneurysms but even as supplementary procedures to prolong the longevity of a valve repair.Our article gives an overview of the background and principles of reconstructive aortic valve procedures for AR in the setting of both a bicuspid and a tricuspid aortic valve. It explains the principles, describes the techniques, and reviews the reported current outcomes after reconstruction of the different components of the aortic root. This overview should help clinicians evaluate the status and relevance of frequently discussed current techniques for the treatment of patients with different types of thoracic aortic aneurysms and AR.The need for lifelong anticoagulation remains the main drawback of prosthetic aortic valve replacement for many young patients living an active lifestyle. In addition to sparing the patient’s native …