Principles of aortic valve repair

During the past 15 years, important advances in the field of aortic valve repair have transformed it from an infrequent and anecdotal exercise to a feasible and attractive alternative to valve replacement in selected patients with pure aortic insufficiency. These advances include a deeper understanding of the functional anatomy of the aortic valve and pathophysiologic mechanisms of aortic insufficiency; the development of surgical techniques to restore normal geometry to the aortic root and to restore the cusp coaptation; and the development of a common terminology that can be used by all clinicians to describe the lesions, discuss repair techniques, and compare immediate and long-term outcomes after aortic valve repair. This article attempts to describe the important principles of aortic valve repair by focusing on functional anatomy, surgical techniques for cusp repair, and outcome. By analogy with mitral valve repair, we include in the term aortic valve repair not only the repair of the cusp but also the valve-sparing root replacement or any kind of functional aortic annulus stabilization.