Aortic Root Remodeling

Valve-preserving aortic root replacement has become an attractive alternative to composite replacement leading to better quality of life and minimal valve-related complications. Root remodeling requires less surgical dissection and has been shown to lead to more physiological hemodynamics compared to valve reimplantation. Over the last 2 decades, improvements have been made regarding assessment of cusp and root configuration. Aggressive correction of cusp prolapse extended the application of root remodeling to a larger patient population and has markedly improved valve stability, even in patients with connective tissue disorders. In the presence of annular dilatation, the addition of an annuloplasty has been shown to be beneficial for valve competence and repair durability. Aortic root remodeling combined with cusp repair and correction of annular dilatation leads to excellent valve stability and minimal valve-related complications.