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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAlthough mitral valve repair is well established, initial reports of the success of aortic valve repair were mixed. A review of 11 studies from 1990 to 2002, including 761 patients who underwent aortic valve repair, reported that the durability of the repairs was unclear and that patients with rheumatic valvular disease had an increased incidence of recurrence and repair failure [Carr JA, Savage EB. \u003Cem\u003EEur J Cardiothorac Surg\u003C\/em\u003E 2004]. Since that report, new standardized techniques have been developed for durable aortic valve repair, making it a viable and favorable option when anatomically possible.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EValvular Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EValvular Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAlthough mitral valve repair is well established, initial reports of the success of aortic valve repair were mixed. A review of 11 studies from 1990 to 2002, including 761 patients who underwent aortic valve repair, reported that the durability of the repairs was unclear and that patients with rheumatic valvular disease had an increased incidence of recurrence and repair failure [Carr JA, Savage EB. \u003Cem\u003EEur J Cardiothorac Surg\u003C\/em\u003E 2004]. However, Edward B. Savage, MD, Cleveland Clinic Florida, Weston, Florida, USA, stated that since that report, new standardized techniques have been developed for durable aortic valve repair, making it a viable and favorable option when anatomically possible.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EConditions that can cause aortic regurgitation (AR) include cusp prolapse, perforation, and retraction. Dilation of the annulus or the sinotubular junction can also lead to regurgitation. The main principle in aortic valve repair is to correct the primary abnormality. The length of the coaptation-free margins should be evened and the height of the leaflets raised, resulting in increased coaptation height.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EOne repair technique involves shortening the length of the free margin of the leaflet by central plication or by free-margin suspension to match the others [Tamer S et al. \u003Cem\u003EAnn Cardiothorac Surg\u003C\/em\u003E 2013]. In patients with annular dilation, subcommissural annuloplasty can be performed, in which a suture is placed and tightened to pull the bottom together and push the leaflets up. Another way to accomplish this is with commissural plication, in which a suture is placed around the commissure outside the aorta to shrink the annular diameter and push the leaflets together.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EA new technique under development in an animal model involves using a ring, which fits beneath the valve with 3 posts fitting into the commissures to match the normal configuration of the aortic root [Rankin JS et al. \u003Cem\u003EJ Thorac Cardiovasc Surg\u003C\/em\u003E 2011]. According to Dr. Savage, the ring will reduce the diameter of and stabilize the annulus. One note of caution is that fibrosis might develop on the valve, affecting the leaflets, so long-term follow-up is needed to assess the durability of these devices.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAnother repair method, if there is inadequate valve tissue, is augmentation using the patient\u0027s pericardium as a patch, which is glutaraldehyde fixed and sutured to the free margin of the leaflet. Good long-term results of this technique have been published, but the patch can calcify and restrict leaflet motion.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EA study evaluating aortic valve repair with cusp or root repair or a combination of both reported comparable freedom from AR greater than or equal to grade 2 in repaired bicuspid and tricuspid valves (p = .95; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Aicher D et al. \u003Cem\u003EEur J Cardiothorac Surg\u003C\/em\u003E 2010]. There was a significant improvement in freedom from AR greater than or equal to grade 2 for repairs performed during more recent years, demonstrating the influence of valve repair experience (log-rank p = .025). Freedom from reoperation at 10 years was 81% in bicuspid valves and 93% in tricuspid valves (p = .0013), while freedom from valve replacement was 90% in bicuspid valves and 94% in tricuspid valves (p = .36).\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/24\/24.2\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Ten-Year Results of Aortic Valve Repair\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1216852088\u0022 data-figure-caption=\u0022Ten-Year Results of Aortic Valve Repair\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/24\/24.2\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/24\/24.2\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/24\/24.2\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14796\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003ETen-Year Results of Aortic Valve Repair\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EAR=aortic regurgitation.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Aicher D, Fries R, Rodionycheva S, Schmidt K, Langer F, Sch\u00e4fers HJ. Aortic valve repair leads to a low incidence of valve-related complications. \u003Cem\u003EEur J Cardiothorac Surg.\u003C\/em\u003E 2010;37:127\u2013132. With permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EDr. Savage concluded that aortic valve repair is durable in appropriate situations and is a viable treatment option. He argued that there may be situations in which aortic valve repair is preferable to mechanical or bio-prosthetic valve replacement.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/24\/24.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzow63\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzow63\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}