Commentary: Suture annuloplasty for isolated aortic valve repair: The Holy Grail is yet to be found

Abstract

In their article in this issue of the Journal, Federspiel and colleagues review current techniques for suture annuloplasty during isolated aortic valve repair. Since the initial descriptions of the reimplantation/remodeling techniques by David and Yacoub, significant milestones have been achieved in the field of aortic valve repair for aortic regurgitation. Although initially viewed as more “art” than “science,” significant contributions have led to a better understanding of the concepts of aortic valve repair. Foremost, as elegantly illustrated in the present report, thorough knowledge of the normal anatomy and physiology linked to aortic valve competency is essential. Efforts at standardizing procedures according to different root anatomies have led to a more comprehensive approach to the procedures, and hence better reproducibility. Finally, early echocardiographic findings, such as residual aortic regurgitation and effective leaflet height, have been identified as strong predictors of procedural outcome. Annular dilatation often accompanies aortic regurgitation, especially in the presence of root dilatation. Although the need for concomitant annuloplasty during root remodeling procedures is a matter of debate, the general consensus is that annuloplasty is required in cases of an annulus size >25 to 27 mm. A reimplantation technique has been shown to be effective for annular reduction and stabilization in the presence of root and annular dilatation. The ideal