Closing remarks

In summary, the clinical course of patients with AR is suboptimal. AVP has attracted a great deal of attention as both mechanical and biological AVR have major disadvantages. Nonetheless, AVP has not been widely adopted due to the complexity of its technique and assessment. Due to recent technical and theoretical advances, AVP is anticipated to be increasingly performed with better outcomes. A number of prospective multicenter studies, such as CAVIAAR45, AVIATOR27, and Japanese Registry (UMIN000016145), are currently underway and will clarify the actual role of AVP in surgical treatment of AR in the near future.