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Background: Valve-sparing aortic root replacement such as the reimplantation (David) procedure is becoming increasingly popular. Despite the fact that the procedure is technically more complex, long-term studies demonstrated that excellent clinical outcomes in selected patients with durable repair are achievable. Benefits of minimal access cardiac surgery have stimulated enthusiasm in the use of this access for valve-sparing aortic root replacement., Methods: We have reviewed available literature on the topic of valve-sparing aortic root replacement (David procedure) via minimally invasive access through upper hemisternotomy in an attempt to assess current trends and to recognize potential advantages of this technique. Patient selection and preoperative work-up play important role in performing minimally invasive David procedure safely. Surgical technique corresponds to the standard David procedure, with a few exceptions related to the minimal access, and is performed via upper ministernotomy., Results and Conclusion: Evidence from nonrandomized observational and comparative studies demonstrated excellent clinical outcomes of minimally invasive David procedure in selected patients with comparable perioperative mortality and outcomes to the conventional technique. To date, David procedure with a minimal access technique has been performed in carefully selected patients. We believe it could be particularly beneficial to provide younger patients (Marfan syndrome and bicuspid aortic valve) with minimally invasive David procedure as it can allow faster recovery with improved cosmesis with excellent outcomes. A decision to perform minimally invasive David procedure should be individualized to each patient and based on the experience of the team. Further large prospective randomized studies with long-term follow-up are still needed to confirm durability of minimal access technique., (© 2022 Wiley Periodicals LLC.)

Balloon aortic valvuloplasty has a role in a select group of patients with severe aortic stenosis. Identifying those appropriate patients who will benefit most is key. Given previous evidence demonstrating that histologically the intervention involves a physical disrupting of the cusp's calcium we hypothesized that the quantity of calcium seen at CT will influence outcome. We examined our cohort of patients who had undergone balloon aortic valvuloplasty and CT-quantified aortic valve calcium (AVC) between July 2011 and April 2014. All patients underwent echocardiography pre- and post-procedure and for those patients managed medically, again at 6 months. A potential predictive AVC value for mortality was calculated using Youden's index. A total of 240 aortic valvuloplasties were performed in 206 patients (male = 124). Valvuloplasty caused a significant (pre 0.63 ± 0.21 vs post 0.77 ± 0.27 cm 2 , p <0.01, n = 240), but temporary (post 0.80 ± 0.27 vs 6 months: 0.64 ± 0.18 cm 2 , p <0.01, n = 88) increase in valve area. Those patients with a non-severe AVC (<1853.5 AU) had a larger increase in valve area after valvuloplasty compared with those with more calcium (0.10 [95% confidence interval {CI} 0.05 to 0.10] vs 0.15 [95%CI 0.10 to 0.22] cm 2 , p = 0.049). Multivariate analysis revealed severe AVC (Hazard ratio 2.79, 95% CI 1.18 to 6.63, p = 0.02) along with pulmonary artery pressure post-valvuloplasty (Hazard ratio 1.02, 95% CI 1.00 to 1.03, p = 0.03) to be predictive of survival. In conclusion, in patients with severe aortic stenosis the degree of AVC impacts on the success of valvuloplasty., (Copyright © 2018. Published by Elsevier Inc.)

Surgical aortic valve replacement is the treatment of choice in patients with severe symptomatic aortic valve stenosis because it provides excellent early and long-term clinical outcomes in terms of hemodynamics, valve durability, and freedom from valve-related complications. In recent years, the number of high-risk patients being referred for surgical aortic valve replacement has increased. A considerable proportion of these patients are deemed operable despite the high risk. In order to modify the risk predominantly associated with duration of cardiopulmonary bypass and cross clamp time sutureless aortic valve technology has been developed. Sutureless aortic bioprosthetic valves, introduced in clinical practice in 2009, contrary to the conventional surgical technique for implantation (interrupted or continuous sutures, after thorough annular decalcification) are not hand sewn. This technological modification reduces the implantation time with potential translation into improved outcomes for high-risk patients undergoing surgical aortic valve replacement. Currently, three sutureless bioprostheses are available and amongst these the largest published experience is available for the patented and CE marked truly sutureless PERCEVAL S valve (Sorin Group, Saluggia, Italy). This article provides an overview of the published literature for Perceval S valve with an attempt to better define the role of sutureless aortic valve replacement in the treatment of critical aortic valve stenosis.

The reimplantation technique for valve sparing aortic root replacement (David I) has improved management of patients with aortic root aneurysm and structurally normal aortic valves. The Valsalva graft (Gelweave Valsalva, Sultzer Vascutek, Renfrewshire, Scotland) further simplified the procedure by offering a root prosthesis with preformed neo-sinuses that may reduce physiologic stresses on valve leaflets and improve long-term valve durability. However, in-conduit suturing of the aortic valve annulus and a small rim of sinus remnant to the graft sinuses may create folds of the sinus remnant that lead to bleeding or distortion of the prosthetic root. We report a method to minimize crimping of the aortic graft sinuses., (Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)

The management of aortic valve disease in children and young adults is often a controversial and complex problem. The Ross operation has become an important option for aortic valve replacement in patients with both congenital and acquired disease of the left ventricular outflow tract (LVOT). The acceptance of this procedure has been slow because of the technical demands of the operation and the inherent need for reconstruction of the right ventricular out-flow tract (RVOT), thereby placing two valves at risk. Although more than three decades have passed since the Ross operation was first described, it is only during the past 10 years that it has been increasingly considered for pediatric patients with a wide spectrum of congenital abnormalities of the LVOT. The advantages of the autograft valve include growth potential, optimal hemodynamic performance, and freedom from anticoagulation and hemolysis. However, concerns regarding potential dilatation of the autograft, reoperation for autograft dysfunction, and replacement of RVOT conduits persist. Further, doubts have been expressed by others regarding the indications for the Ross operation in patients with a bicuspid aortic valve and with aortic valve insufficiency. This review evaluates existing evidence on the safety and efficacy of Ross procedure for pediatric and adolescent patients.

Past four decades have seen a gradual evolution in aortic valve replacement surgery. The ideal valve substitute should combine central flow, low transvalvular gradient, low thrombogenicity, durability, easy availability, resistance to infection, freedom from anticoagulation, and easy implantability. Although there are several types of valves available to replace the diseased aortic valve-autograft, allograft, xenograft, mechanical, and bioprosthetic valves-none is ideal. On one end of the spectrum is the pulmonary autograft, which comes closest to achieving these goals, but creates a double valve procedure for single valve disease, while on the other end are the mechanical valves and stented tissue valves, which allow easy "off the shelf" availability as well as easy implantability but are limited by the potential drawback of causing intrinsic obstruction to some extent because of the space occupied by the stent and sewing ring. Stentless xenograft aortic valves have been developed as a compromise between these ends of the valve spectrum. Stentless aortic valves have been reported to provide more physiologic hemodynamic behavior and cause more timely and thorough regression of ventricular hypertrophy. This review article attempts to evaluate current best available evidence from randomized controlled trials to assess the impact of stentless aortic valves on left ventricular function and hypertrophy.

The Ross procedure is being used increasingly to treat aortic valve disease in pediatric patients; however, there is an ongoing dispute about the durability of the autograft. From November 1996 to September 2003, 32 pediatric patients (mean age, 11 +/- 4.5 years) underwent the Ross procedure for various aortic valve diseases, using the root replacement technique. Clinical and echocardiographic follow-up was performed early (within 30 days), at 3 to 6 months, and yearly after surgery. There were no perioperative deaths. The patients were followed-up for up to 7 years with a median interval of 36 months. Actuarial survival at 7 years was 96% +/- 3% and there was 100% freedom from re-operation for autograft valve dysfunction or any other cause. The autograft annulus and sinus increased significantly in size during follow-up and the increase in size paralleled the increase in body surface area, with no evidence of disproportional dilatation. The hemodynamics at the latest follow-up were also similar to those at the time of discharge after surgery. Pulmonary autograft replacement of the aortic valve appears to be the ideal solution in pediatric patients, because of relatively low operative risk, excellent late valve function, and real potential for growth.

Background: The ideal prosthesis for aortic valve replacement in children and young adults has not been found yet. In recent years there has been a renewed interest in the replacement of aortic valve with the pulmonary autograft owing to its advantages of lack of anticoagulation, potential for growth and excellent haemodynamic performance. The purpose of this study was to review our institutional experience at Alder Hey hospital with the Ross procedure in children and young adults., Methods: From November 1996 to September 2003, 38 patients (mean age, 13.1 +/- 5.7 years) underwent the Ross procedure for various aortic valve diseases using the root replacement technique. Clinical and echocardiographic follow-up was performed early (within 30 days), 3 to 6 months, and yearly after surgery. Medical records of all patients were reviewed retrospectively., Results: There was 1 perioperative death. The patients were followed-up for a median interval of 36 months and up to 7 years. One patient died 3 years after surgery secondary to ventricular arrhythmia with overall mortality of 5.3%. Actuarial survival at 7 years was 94 +/- 2.5% and there was 100% freedom from reoperation for autograft valve dysfunction or any other cause. Balloon dilatation was required in 2 patients for pulmonary homograft stenosis. The haemodynamics at the latest follow-up were also similar to those at the time of discharge after surgery. There was no progression in the degree of aortic regurgitation for 11 patients with trivial and 3 with mild regurgitation., Conclusion: Our experience demonstrates that Ross operation is an attractive option for aortic valve replacement in children and young adults. Not only can the operation be accomplished with a low operative risk but the valve function stays normal over a long period of time with minimal alteration in lifestyle and no need for repeated operations to replace the valve as a result of somatic growth of the children.