Aortic valve reconstruction: why, when, and how?

After almost 20 years aortic root reconstruction modalities have evolved into reasonable and useful surgical measures. Short and long term results match those of aortic composite replacement. Three major restitution strategies have found widespread acceptance: Root replacement with valve reimplantation (David-Procedure), root remodeling (Yacoub-procedure), or commissural resuspension. In the wake of these modalities also isolated aortic valve repair techniques have found renewed interest in order to broaden the indication for reconstructive surgery. Some euphemistic and hence biased interpretation, however, should be considered when looking at the clinical results. Reimplantation and remodeling procedures as well as several valve repair maneuvers are technically demanding unfolding their potential only in the hands of an experienced surgeon. Definite guidelines regarding the appropriate method of restitution required to serve best in the patient's individual situation are not yet at hand although they are about to emerge.