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Aortic valve cusp prolapse before and after valve-sparing aortic root replacement
  1. Marek A Deja
  1. Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
  1. Correspondence to Professor Marek A Deja, Department of Cardiac Surgery, Medical University of Silesia, Katowice 40-035, Poland; mdeja{at}

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Composite aortic valve-root conduit replacement has been the mainstay and a ‘gold standard’ of aortic root aneurysm surgery for the last half century. The main limitation of this procedure had been the inclusion of a prosthetic aortic valve replacement, which brings with it valve-related complications. Thirty years ago, valve-sparing aortic root replacement was developed enabling the preservation of a healthy aortic valve when treating aortic root aneurysm. Two gianst of cardiac surgery, Magdi Yacoub1 and Tirone David2 noted that an otherwise healthy aortic valve becomes incompetent in aneurysmal root, because the cusps are pulled apart by the stretched aortic wall. By bringing the commissures closer when replacing the root, the normal valve function was restored and valve replacement was evaded (figure 1). With excellent long-term results and avoidance of valve-related complication, the valve-sparing root replacement became a class I recommendation, especially in young adults.3

Figure 1

The aortic valve leaflet edges between the commissures behave somewhat like ropes between the posts. In the normal situation, they reach the half height of the sinuses (A). In the aneurysm, the commissures spread away. With the posts further apart, the ropes hang less—the leaflets become restrictive (B). The root repair brings the commissures closer. If the posts are pulled close together, the ropes will drop down—the leaflets prolapse (C). If the intercommissural distances are manipulated, the leaflets will change their position as well. The leaflets with decreased intercommissural distance will tend to prolapse and those with increased intercommissural distance will become restrictive (D). Łukasz Morkisz has drawn the …

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  • Contributors MAD is responsible for the content of this manuscript. He has conceived the idea of this editorial, drafted, edited and written the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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