Abstract
Nowadays, despite the rapid advancements in interventional cardiology, open surgery
still deals with aortic root diseases, to assure the best “ad hoc” treatment. In case
of middle-aged adult patients, the optimal operation still represents a matter of
debate. A review of the last 10-year literature was conducted, focusing on patients
below 65 to 70 years of age. Because of the small sample and the heterogeneity of
the papers, no metanalysis was possible. Bentall–de Bono procedure, valve sparing,
and Ross operations are the surgical options currently available. The main issues
in the Bentall – de Bono operation are lifelong anticoagulation therapy and cavitation
in case of mechanical prosthesis implantation and structural valve degeneration in
case of biological Bentall. As transcatheter procedures are currently performed as
valve in valve, biological prosthesis may be preferable, if the diameter may prevent
postoperative high gradients. Conservative techniques, such as remodeling and reimplantation,
preferred in the young, guarantee physiologic aortic root dynamics and impose surgical
analysis of the aortic root structures to get a durable result. The Ross operation,
which shows excellent performance, involves autologous pulmonary valve implantation
and is performed only in experienced and high-volume centers. Due to its technical
difficulty, it requires a steep learning curve and presents some limitations in specific
aortic valve diseases. All three have advantages and downsides, and no ideal solution
has still been reported.
Keywords
aortic root - aortic root surgery - Bentall's procedure - valve-sparing operations
- Ross' operation
