Aortic Valve Sparing Operations: A Review

Aortic valve sparing operations were developed to preserve the native aortic valve during surgery for aortic root aneurysm as well as surgery for ascending aortic aneurysms with associated aortic insufficiency. There are basically two types of aortic valve sparing oprations: remodeling of the aortic root and reimplantation of the aortic valve. These operations have been performed for over two decades and the clinical outcomes have been excellent in experienced hands. Although remodeling of the aortic root is physiologically superior to reimplantation of the aortic valve, long-term follow-up suggests that the latter is associated with lower risk of developing aortic insufficiency. Failure of remodeling of the aortic root is often due to dilatation of the aortic annulus. Thus, this type of aortic valve sparing should be reserved for older patients with ascending aortic aneurysm and normal aortic annulus whereas reimplantation of the aortic valve is more appropriate for young patients with inherited disorders that cause aortic root aneurysms. This article summarizes the published experience with these two operations. They are no longer experimental procedures and should be part of the surgical armamentarium to treat patients with aortic root aneurysm and ascending aortic aneurysms with associated aortic insufficiency.

Mitral valve replacement with preservation of chordae tendineae

The rationale for the preservation of the chordae tendineae during mitral valve replacement is reviewed in the article. The results of a recent prospective and randomized clinical trial on mitral valve replacement with and without preservation of the chordae tendineae in patients with chronic mitral regurgitation indicated that postoperative left ventricular systolic function as well as left ventricular performance were bettering chordal preservation group. The operative technique employed by the author for mitral valve replacement with preservation of chordae tendineae inpatients with myxomatous and ischemic mitral valve disease is also described. In patients with rheumatic mitral valve disease with excessively fibrotic or calcified leaflets, te valve is completely excised and both papillary muscles are resuspended with multiple Gore-Tex sutures. The clinical experience with 133 patients who had isolated mitral valve replacement with chordal preservation or chordal replacement with Gor-Tex sutures indicates that this technique is associated with low operative mortality and morbidity, and improved long-term survival when compared to historical controls