Perspective: valve sparing root repair: tips and tricks.

The remodeling and the reimplantation procedures were described more than 25 years ago with the aim of sparing otherwise normal aortic valves in the presence of a root aneurysm. Important achievements in this discipline have occurred over the past decade including development and refinement of valve preserving aortic root replacement techniques, development of a classification system for aortic insufficiency, and development of surgical approaches to cusp disease with varying cusp anatomy. The main advantage of the reimplantation is the resulting annular support, and the disadvantages are the unfavorable hemodynamics and relatively longer procedural time. Conversely, the main advantages of remodeling are the physiological hemodynamics and the shorter procedural time, and the disadvantage is the lack of annular support. With technical advances and modifications, however, the differences between these two procedures have narrowed. Today preference for a reimplantation procedure is based on the perception of a better reproducibility of the surgical procedure, an increased procedural safety due to the characteristic hemostatic feature of this surgical approach, the possibility of achieving favorable hemodynamics, and a much larger amount of data present in the literature on long-term results.