**11. Conclusion**

238 Aortic Valve Surgery

Fig. 17. Placement of the aortic prosthetic ring in subvalvular position

of aortic insufficiency ≥ grade 2 and/or reoperation.

From 2003 to 2009, 187 patients underwent Remodeling with subvalvular ring annuloplasty in 14 centers (24 surgeons). Preoperative AI≥grade 2 was present in 67.9% (127), and bicuspid valve in 20.8% (39). Need for cusp repair was assessed according to 3 strategies: Group 1: gross visual estimation (74 patients), Group 2: alignment of cusp free edges (62 patients), Group 3: two-steps approach associating alignment of cusp free edges with effective height resuspension (51 patients). A composite outcome was defined as recurrence

Valve sparing was successful in all but 2 cases. Operative mortality was 3.2% (6). Ring produced a significant annular base reduction from 27.3±0.6 to 20.5±1.7 mm (p<0.01) without significant mean transvalvular gradient (7.2±2.9 mmHg). Treatment of cusp lesion was most frequently performed in Group 3 (70.6%, versus 20.3% Group 1 and 30.6% Group 2, p<0.001). Nine patients required reoperation during follow-up (31.4±4.5 months (1-80)). At one year, no patients in Group 3 presented with composite outcome events (versus 28.1% Group 1, 15% Group 2, p<0.001). Residual aortic insufficiency and tricuspid anatomy were

**9. Preliminary results** 

Avoidance of anticoagulation and prosthetic related complications makes aortic valve repair an appealing procedure. Considering the increasing rate of cusp repair reported in the literature, conservative aortic valve surgery seems to be evolving from aortic valve sparing to aortic valve repair. However, the need remains for reliable long-term data comparing valve replacement and valve-repair procedures. A standardized management of dystrophic aortic roots towards a physiological approach to valve repair might improve long term durability of the results, and encourage more widespread adoption of these procedures.
