Aortic Root Surgery: The Biological Solution

The surgical results of bioprosthetic aortic valve replacement in the 1960s and 1970s were not very satisfactory. The search for the ideal substitute for the diseased aortic valve led Donald Ross to develop the concept of the aortic allograft in 1962 and the pulmonary autograft in 1967 for subcoronary implantation, and later, in 1972, as a full root for replacing the aortic root in the infected aortic valve with a root abscess. The aortic al- graft and pulmonary autograft surgical procedures were revo- tionary in the history of cardiac valve surgery in the last m- lennium because they compete well with the bioprosthesis, are nonthrombogenic (thus, requiring no postoperative anticoa- lation), are resistant to infection, restore the anatomic units of the aortic or pulmonary outflow tract, and offer unimpeded blood flow and excellent hemodynamics, giving patients a b- ter prognosis and quality of life. Surgery for congenital, degenerative, and inflammatory aortic valve and root diseases has now reached a high level of maturity; yet an ideal valve for valve replacement is not available. The- fore, surgeons are focusing their skills and their clinical and s- entific knowledge on optimizing the technical artistry of val- sparing procedures.

The surgical treatment of the aortic valve and root disease, organic and ischemic mitral regurgitation, and endocarditis has made great strides. Still, there is the well-known dilemma: on the one hand the need for anticoagulation in patients with mechanical valves that otherwise guarantee long-term functioning and, on the other, the unpredictable durability of biological substitutes and of valve repair procedures which, per se, do not require anticoagulation. The choice of procedure is determined by factors such as patients' age, metabolic and bleeding disorders, and bleeding preconditions, as well as such critical issues as the desire to bear children in young women.

The book contains a collection of proceedings of The Berlin Heart Valve Symposium which was held in November 2008. It focuses on current surgical approaches to and evolving trends in aortic valve repair, aortic root and valve replacement with pulmonary autograft, aortic allograft, stentless and stented bioprostheses. Further contributions will deal with recent advances in catheter-based percutaneous and transapical techniques, ablation techniques for atrial fibrillation, tissue engineering of heart valves, multi-modality imaging, and anticoagulation.