Aortic Valve Repair and Replacement

A wide spectrum of pathologies can affect aortic valve function leading to hemodynamically significant aortic stenosis or regurgitation. Aortic stenosis (AS) can be caused by degenerative calcification, bicuspid aortic anatomy, endocarditis, or rheumatic AS, to name a few. Acute aortic regurgitation (AR) can occur in the setting of endocarditis, dissection, or trauma, whereas chronic AR occurs due to distortion of valve leaflets or dilation of the aortic root. When surgical indications are met, patients should undergo an aortic valve replacement or repair. With replacement, the selection of prosthesis is nuanced and requires a thorough review of the benefits and disadvantages specific to each valve type and patient. In select patients, aortic valve repair may be an option, but requires careful consideration of the size and quality of the aortic cusps, size of the aortic root, and possible reimplantation. Additional considerations when evaluating surgical aortic valve disease are small aortic root, prosthetic valve-patient mismatch, and paravalvular regurgitation.