The natural history of patients with aortic regurgitation (AR) is not as
benign as once believed, even in asymptomatic patients with preserved
left ventricular function. Aortic valve surgery can prolong survival of
these patients. However, both mechanical and biological aortic valve
replacement have major disadvantages, especially in young patients.
Aortic valve-preserving surgery (AVP) has attracted a great deal of
attention as it has significant survival benefit over replacement.
Nonetheless, AVP has not been widely adopted due to the complexity of
its technique and assessment (i.e., long learning curve). With recent
technical and theoretical advances, AVP has increasingly been performed
with better outcomes, and therefore earlier indication for surgical
intervention in cases of AR has been considered. Recent advances in AVP
include repair-oriented classification of the etiology of AR, objective
assessment of the cusp configuration (i.e., effective height and
geometric height), use of aortic annuloplasty, introduction of two
reproducible valve-sparing root replacement procedures (i.e., aortic
valve reimplantation and aortic root remodeling techniques),
standardization of AVP, and assessment of cusp configuration with
aortoscopy. A number of prospective multicenter studies are currently
underway and will clarify the role of AVP in surgical treatment of AR in
the near future.