Prospective surgical strategies for type 1 A aortic insufficiency
Abstract Background The El-Khoury’s classification of aortic insufficiency mirrors the well-established Carpentier’s classification for mitral insufficiency but takes the classification schema a step further by subcategorizing type 1 AI. At most centers, even high-volume aortic centers, any root pat...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2025-07-01
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| Series: | The Cardiothoracic Surgeon |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s43057-025-00165-1 |
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| Summary: | Abstract Background The El-Khoury’s classification of aortic insufficiency mirrors the well-established Carpentier’s classification for mitral insufficiency but takes the classification schema a step further by subcategorizing type 1 AI. At most centers, even high-volume aortic centers, any root pathology with associated aortic valve disease is treated with concomitant root and aortic valve replacement with a valved conduit. The focus of this review is to highlight which valve-sparing root procedures could be best applied to specific root pathologies with associated AI, as a potential procedural algorithm. Main body For type 1a AI—normal appearing cusps with STJ dilation and type 1c AI—normal appearing cusps with isolated annular dilation (i.e., annuloaortic ectasia), the Florida Sleeve procedure is a viable option. For type 1b AI—normal appearing cusps with sinus and STJ dilation, the well-established valve sparing root remodeling and reimplantation techniques have been described as an effective option to re-establish aortic valve function. Ultimately, the root procedure performed for patients with AI needs to be tailored to the patient’s pathology and what’s feasible. If upon inspection there is a calcified annulus or cusps, or prolapsed or restricted cusp—a modified Bentall procedure is still a durable and viable option, especially at centers not well versed in aortic valve repair. Conclusions With a greater understanding of root anatomy, function, and pathology (i.e., type 1 AI), the optimal procedure can be performed for a patient based on their goals and with consideration for their risk profile. |
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| ISSN: | 2662-2203 |