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Laurent De Kerchove - One of the best experts on this subject based on the ideXlab platform.
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Techniques in trileaflet Aortic Valve Repair
Journal of Visualized Surgery, 2019Co-Authors: Mohammed Morjan, Laurent De Kerchove, Saadallah Tamer, Gaby Aphram, Gebrine El KhouryAbstract:Surgical techniques for regurgitant Aortic Valve pathology have evolved significantly in the last 20 years as a result of deeper understanding of functional structure and physiopathology of the Aortic Valve and the development of a common anatomical and functional language among specialists. The introduction of the functional classification of Aortic Valve regurgitation facilitated the development of standard surgical approaches to treat this pathology. The principles of Aortic Valve Repair include the restoration of normal anatomy and geometry of the functional Aortic root with the aim to provide a long-term stabilisation of the Aortic annulus. We report a review of our approach and surgical techniques to Repair the Aortic Valve and Aortic root based on our long experience in the field.
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the role of annular dimension and annuloplasty in tricuspid Aortic Valve Repair
European Journal of Cardio-Thoracic Surgery, 2016Co-Authors: Laurent De Kerchove, Munir Boodhwani, Jean-louis Vanoverschelde, Stefano Mastrobuoni, Parla Astarci, Jean Rubay, Alain Poncelet, Philippe Noirhomme, Gebrine El KhouryAbstract:Valve sparing reimplantation can improve the durability of bicuspid Aortic Valve Repair compared with subcommissural annuloplasty, especially in patients with a large basal ring. This study analyses the effect of basal ring size and annuloplasty on Valve Repair in the setting of a tricuspid Aortic Valve.
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The role of the ventriculo-Aortic junction and annuloplasty in Aortic Valve Repair
2014Co-Authors: Laurent De KerchoveAbstract:In Aortic Valve Repair, a large ventriculo-Aortic junction as well as a low coaptation height has been found to jeopardize Repair stability due to the increased cusp stress and low coaptation reserve. The Repair procedure aims to correct all geometrical issues and restore a stable balance between the root and cusp size. While Aortic Valve Repair cannot stop the degenerative process by itself, it can correct damage caused by the degenerative process and reinforce certain structures. The ventriculo-Aortic junction is a tridimensional oval-shaped structure deeply embedded in the heart, which supports the base of the Aortic cusp insertion. In a normal Aortic Valve, ventriculo-Aortic junction size is closely related to body surface area. In the pathological setting, such as with chronic Aortic regurgitation, Aortic root aneurysm, or bicuspid Aortic Valve, the ventriculo-Aortic junction can be substantially larger in size, thus out of proportion with body size. In patients undergoing Aortic Valve Repair, a ventriculo-Aortic junction ≥28mm is an indication for performing a stable circumferential annuloplasty of this junction. When the junction is inferior to 28mm, annuloplasty is not systematically indicated and should be guided by the ratio between cusp and ventriculo-Aortic junction size. Patients exhibiting a ventriculo-Aortic junction ≥28mm and root dilatation should be treated with Valve-sparing reimplantation or Valve-sparing remodeling with circumferential annuloplasty. Those exhibiting a ventriculo-Aortic junction ≥28mm and no root dilatation should undergo either Valve sparing reimplantation or a circumferential annuloplasty without root replacement. Currently, Valve sparing reimplantation is our technique of choice to treat patients presenting with ventriculo-Aortic junction dilatation given the stability of its annuloplasty and the capacity to reshape the entire Aortic Valve geometry. Additional studies are necessary to evaluate the final impact on Valve function and long-term results of the new circumferential annuloplasty techniques without root replacement, as well as to establish the role these would play in the spectrum of Aortic Valve Repair.
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Abstract 18226: Finding the Ideal Biomaterial for Aortic Valve Repair
Circulation, 2013Co-Authors: Hadi Toeg, Laurent De Kerchove, Ovais Abessi, Talal Al-atassi, Gebrine Elkhoury, Michel R. Labrosse, Munir BoodhwaniAbstract:Objectives: Cusp replacement in Aortic Valve Repair (AVr) is associated with increased long-term Repair failure. We measured hemodynamic and biomaterial properties after porcine AVr with 4 types of...
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effect of annulus dimension and annuloplasty on bicuspid Aortic Valve Repair
European Journal of Cardio-Thoracic Surgery, 2013Co-Authors: Emiliano Navarra, David Glineur, Gebrine El Khoury, Munir Boodhwani, Jean-louis Vanoverschelde, Michel Van Dyck, Philippe Noirhomme, Laurent De KerchoveAbstract:OBJECTIVES: We have recently shown that Valve sparing reimplantation (VSR) improves the durability of bicuspid Aortic Valve Repair in comparison with subcommissural annuloplasty. The aim of this study was to assess the degree of annular reduction provided by these techniques and to correlate these findings with Repair durability. METHODS: From 1995 to 2010, 161 patients underwent bicuspid Valve Repair. We included only patients with subcommissural annuloplasty or reimplantation having intraoperative pre- and post-Repair transoesophageal echocardiography images. Pre- and post-Repair ventriculo-Aortic junction (VAJ) diameters were measured on long axis views. Inclusion criteria were met by 53 patients with subcommissual annuloplasty and 65 with reimplantation. Median follow-up was 53 months in the subcommissual annuloplasty group and 42 months in the reimplantation group. Follow-up completeness was 100% in subcommissural annuloplasty and 94% in reimplantation. RESULTS: There was no operative or late mortality. Mean preoperative VAJ was similar in both groups (reimplantation: 28 ± 3 mm vs subcommissural annuloplasty: 28 ± 3, P = 0.16). Preoperative VAJ was larger in patients 1+. In the subcommissural annuloplasty group, VAJ≥ 30 mm preoperatively and ≥ 25 mm postoperatively were associated with decreased 6 years freedom from recurrent AR>1+ ( 1+ (P = 0.93). CONCLUSIONS: In bicuspid Aortic Valve Repair, the circumferential annuloplasty of VSR offers greater reduction of VAJ compared with the non-circumferential annuloplasty provided by the subcommissural annuloplasty. The degree and extent of VAJ reduction in reimplantation seem to be factors among others that positively influence Repair durability particularly in patients with a large VAJ (≥ 30 mm).
Gebrine El Khoury - One of the best experts on this subject based on the ideXlab platform.
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Techniques in trileaflet Aortic Valve Repair
Journal of Visualized Surgery, 2019Co-Authors: Mohammed Morjan, Laurent De Kerchove, Saadallah Tamer, Gaby Aphram, Gebrine El KhouryAbstract:Surgical techniques for regurgitant Aortic Valve pathology have evolved significantly in the last 20 years as a result of deeper understanding of functional structure and physiopathology of the Aortic Valve and the development of a common anatomical and functional language among specialists. The introduction of the functional classification of Aortic Valve regurgitation facilitated the development of standard surgical approaches to treat this pathology. The principles of Aortic Valve Repair include the restoration of normal anatomy and geometry of the functional Aortic root with the aim to provide a long-term stabilisation of the Aortic annulus. We report a review of our approach and surgical techniques to Repair the Aortic Valve and Aortic root based on our long experience in the field.
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the role of annular dimension and annuloplasty in tricuspid Aortic Valve Repair
European Journal of Cardio-Thoracic Surgery, 2016Co-Authors: Laurent De Kerchove, Munir Boodhwani, Jean-louis Vanoverschelde, Stefano Mastrobuoni, Parla Astarci, Jean Rubay, Alain Poncelet, Philippe Noirhomme, Gebrine El KhouryAbstract:Valve sparing reimplantation can improve the durability of bicuspid Aortic Valve Repair compared with subcommissural annuloplasty, especially in patients with a large basal ring. This study analyses the effect of basal ring size and annuloplasty on Valve Repair in the setting of a tricuspid Aortic Valve.
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Can the Results of Aortic Valve Repair Equal the Results of a Biologic Aortic Valve Replacement
Aorta (Stamford Conn.), 2014Co-Authors: Mohamad Bashir, Gebrine El Khoury, Ruggero De Paulis, Michael A. Borger, Joseph E. Bavaria, John A. ElefteraidesAbstract:Aortic Valve replacement (AVR) has been the default procedure for the surgical management of Aortic Valve disease, with Repair techniques heterogeneously and infrequently used. However, surgical Aortic Valve Repair has evolved with improved techniques. Yet many questions remain regarding the ideal techniques and real-world applicability and effectiveness of Valve Repair. The AORTA Great Debate highlighted and discussed the controversies regarding the surgical management of Aortic Valve disease.
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effect of annulus dimension and annuloplasty on bicuspid Aortic Valve Repair
European Journal of Cardio-Thoracic Surgery, 2013Co-Authors: Emiliano Navarra, David Glineur, Gebrine El Khoury, Munir Boodhwani, Jean-louis Vanoverschelde, Michel Van Dyck, Philippe Noirhomme, Laurent De KerchoveAbstract:OBJECTIVES: We have recently shown that Valve sparing reimplantation (VSR) improves the durability of bicuspid Aortic Valve Repair in comparison with subcommissural annuloplasty. The aim of this study was to assess the degree of annular reduction provided by these techniques and to correlate these findings with Repair durability. METHODS: From 1995 to 2010, 161 patients underwent bicuspid Valve Repair. We included only patients with subcommissural annuloplasty or reimplantation having intraoperative pre- and post-Repair transoesophageal echocardiography images. Pre- and post-Repair ventriculo-Aortic junction (VAJ) diameters were measured on long axis views. Inclusion criteria were met by 53 patients with subcommissual annuloplasty and 65 with reimplantation. Median follow-up was 53 months in the subcommissual annuloplasty group and 42 months in the reimplantation group. Follow-up completeness was 100% in subcommissural annuloplasty and 94% in reimplantation. RESULTS: There was no operative or late mortality. Mean preoperative VAJ was similar in both groups (reimplantation: 28 ± 3 mm vs subcommissural annuloplasty: 28 ± 3, P = 0.16). Preoperative VAJ was larger in patients 1+. In the subcommissural annuloplasty group, VAJ≥ 30 mm preoperatively and ≥ 25 mm postoperatively were associated with decreased 6 years freedom from recurrent AR>1+ ( 1+ (P = 0.93). CONCLUSIONS: In bicuspid Aortic Valve Repair, the circumferential annuloplasty of VSR offers greater reduction of VAJ compared with the non-circumferential annuloplasty provided by the subcommissural annuloplasty. The degree and extent of VAJ reduction in reimplantation seem to be factors among others that positively influence Repair durability particularly in patients with a large VAJ (≥ 30 mm).
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Video-atlas of Aortic Valve Repair
Annals of cardiothoracic surgery, 2013Co-Authors: Saadallah Tamer, Laurent De Kerchove, David Glineur, Gebrine El KhouryAbstract:Reconstructive surgery of the Aortic Valve is a recent development in our center, based on old roots. In the 1950s and 1960s, the first Aortic procedures were performed with neither adequate echocardiography nor clear understanding of Aortic Valve geometry; those early attempts were of limited clinical outcome. Meanwhile, the availability of Valve substitutes enabled more reproducible and consistent results. Nowadays, with the help of transesophageal echocardiography, and the discovery of the limitations of Valve substitutes, Aortic Valve Repair has become an inspiration for many surgeons. Our videos on Aortic Valve Repair aim at showing our viewers the latest and most relevant techniques in Aortic Valve Repair surgery, whether it concerns tricuspid or bicuspid Valves.
Munir Boodhwani - One of the best experts on this subject based on the ideXlab platform.
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Aortic Valve Repair: From Concept to Future Targets.
Seminars in thoracic and cardiovascular surgery, 2019Co-Authors: Ming Hao Guo, Munir BoodhwaniAbstract:Aortic Valve Repair has become an important treatment alternative to patients with Aortic insufficiency. In this paper, we review refinements and advances in the understanding of core concepts of Aortic Valve anatomy and pathophysiology which have enhanced our approach to Aortic Valve preservation and Repair. With these improvements in understanding and techniques, the outcome for Aortic Valve Repair continues to improve. We also review current challenges in the field and explore potential areas of innovation and future study including timing of surgical intervention for Aortic insufficiency, comparisons between Aortic Valve Repair and replacement in randomized trials, and development of personalized surgical management plan based on patient-specific pathologies. These advances will further establish the role of Aortic Valve Repair in the management of Aortic Valve and Aortic disease.
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the role of annular dimension and annuloplasty in tricuspid Aortic Valve Repair
European Journal of Cardio-Thoracic Surgery, 2016Co-Authors: Laurent De Kerchove, Munir Boodhwani, Jean-louis Vanoverschelde, Stefano Mastrobuoni, Parla Astarci, Jean Rubay, Alain Poncelet, Philippe Noirhomme, Gebrine El KhouryAbstract:Valve sparing reimplantation can improve the durability of bicuspid Aortic Valve Repair compared with subcommissural annuloplasty, especially in patients with a large basal ring. This study analyses the effect of basal ring size and annuloplasty on Valve Repair in the setting of a tricuspid Aortic Valve.
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Aortic Valve Repair: Indications and Outcomes
Current Cardiology Reports, 2014Co-Authors: Munir Boodhwani, Gebrine El KhouryAbstract:Aortic Valve replacement has traditionally been the treatment of choice for patients with Aortic Valve insufficiency with or without Aortic root pathology. Aortic Valve Repair is emerging as an attractive treatment alternative that avoids the long-term risks associated with prosthetic Valve implantation including thromboembolism, endocarditis, prosthetic Valve deterioration, and anticoagulation related hemorrhage. Important achievements in this discipline have occurred over the past decade including development and refinement of Valve preserving Aortic root replacement techniques, development of a classification system for Aortic insufficiency, surgical approaches to cusp disease with varying cusp anatomy. As surgical techniques for Aortic Valve Repair continue to evolve, clinical outcomes up to and beyond the first decade are promising with excellent survival and low risk of Valve related events.
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Abstract 18226: Finding the Ideal Biomaterial for Aortic Valve Repair
Circulation, 2013Co-Authors: Hadi Toeg, Laurent De Kerchove, Ovais Abessi, Talal Al-atassi, Gebrine Elkhoury, Michel R. Labrosse, Munir BoodhwaniAbstract:Objectives: Cusp replacement in Aortic Valve Repair (AVr) is associated with increased long-term Repair failure. We measured hemodynamic and biomaterial properties after porcine AVr with 4 types of...
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effect of annulus dimension and annuloplasty on bicuspid Aortic Valve Repair
European Journal of Cardio-Thoracic Surgery, 2013Co-Authors: Emiliano Navarra, David Glineur, Gebrine El Khoury, Munir Boodhwani, Jean-louis Vanoverschelde, Michel Van Dyck, Philippe Noirhomme, Laurent De KerchoveAbstract:OBJECTIVES: We have recently shown that Valve sparing reimplantation (VSR) improves the durability of bicuspid Aortic Valve Repair in comparison with subcommissural annuloplasty. The aim of this study was to assess the degree of annular reduction provided by these techniques and to correlate these findings with Repair durability. METHODS: From 1995 to 2010, 161 patients underwent bicuspid Valve Repair. We included only patients with subcommissural annuloplasty or reimplantation having intraoperative pre- and post-Repair transoesophageal echocardiography images. Pre- and post-Repair ventriculo-Aortic junction (VAJ) diameters were measured on long axis views. Inclusion criteria were met by 53 patients with subcommissual annuloplasty and 65 with reimplantation. Median follow-up was 53 months in the subcommissual annuloplasty group and 42 months in the reimplantation group. Follow-up completeness was 100% in subcommissural annuloplasty and 94% in reimplantation. RESULTS: There was no operative or late mortality. Mean preoperative VAJ was similar in both groups (reimplantation: 28 ± 3 mm vs subcommissural annuloplasty: 28 ± 3, P = 0.16). Preoperative VAJ was larger in patients 1+. In the subcommissural annuloplasty group, VAJ≥ 30 mm preoperatively and ≥ 25 mm postoperatively were associated with decreased 6 years freedom from recurrent AR>1+ ( 1+ (P = 0.93). CONCLUSIONS: In bicuspid Aortic Valve Repair, the circumferential annuloplasty of VSR offers greater reduction of VAJ compared with the non-circumferential annuloplasty provided by the subcommissural annuloplasty. The degree and extent of VAJ reduction in reimplantation seem to be factors among others that positively influence Repair durability particularly in patients with a large VAJ (≥ 30 mm).
Srinivasan Muralidharan - One of the best experts on this subject based on the ideXlab platform.
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Aortic Valve Repair in young patients with ventricular septal defect with Aortic regurgitation- our experience
Indian Journal of Thoracic and Cardiovascular Surgery, 2013Co-Authors: Nagarajan Muthialu, Soundaravalli Balakrishnan, Rajani Sundar, Srinivasan MuralidharanAbstract:Background Perimembranous and sub arterial Ventricular Septal Defects (VSD) are associated with Aortic Regurgitation (AR) in 5 % of patients. More than mild AR needs additional Valve intervention during VSD closure. Feasibility of Aortic Valve Repair and its superior results over Aortic Valve replacement have been documented well. The purpose of this study is to present our initial experience in Aortic Valve Repair in young children with Aortic regurgitation. Materials and methods Fourteen out of thirty-one consecutive VSD closures had AR (45.16 %) and six of them (19.35 %) needed intervention. The median age and weight were 8.1 years and 18.7 Kg. The VSD was perimembranous in 5 and sub arterial in 1. The predominant pathology was leaflet prolapse in 5 (right coronary cusp-3, Non coronary cusp-1 and both coronary cusps-1) Results Five had successful Aortic Valve Repair and one underwent Aortic Valve replacement after a failed Valve Repair. The technique of Repair consisted of commissural placation with cusp shortening, resuspension and bicuspidisation. There were no deaths. Follow-up was 100 % complete at a median of 6 months. AR was trivial in 2, and mild in 3. All are in NYHA class I. Patient with mechanical Valve had major anticoagulation-related intra-cerebral bleed needing neurosurgical intervention. Conclusion Early intervention for VSD would possibly prevent Aortic Valve disease. Aortic Valve Repair is the procedure of choice in young patients with VSD-AR syndrome and can be performed with low risk, and the freedom from Valve-related morbidity and mortality is excellent. Valve Repair also avoids anticoagulation related complications.
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Aortic Valve Repair in young patients with ventricular septal defect with Aortic regurgitation- our experience
Indian Journal of Thoracic and Cardiovascular Surgery, 2013Co-Authors: Nagarajan Muthialu, Soundaravalli Balakrishnan, Rajani Sundar, Srinivasan MuralidharanAbstract:Background Perimembranous and sub arterial Ventricular Septal Defects (VSD) are associated with Aortic Regurgitation (AR) in 5 % of patients. More than mild AR needs additional Valve intervention during VSD closure. Feasibility of Aortic Valve Repair and its superior results over Aortic Valve replacement have been documented well. The purpose of this study is to present our initial experience in Aortic Valve Repair in young children with Aortic regurgitation.
Hansjoachim Schafers - One of the best experts on this subject based on the ideXlab platform.
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Suture Annuloplasty in Aortic Valve Repair.
The Annals of thoracic surgery, 2016Co-Authors: Ulrich Schneider, Diana Aicher, Yujiro Miura, Hansjoachim SchafersAbstract:There is increasing evidence that an annuloplasty is needed in Aortic Valve Repair. We describe the technique of a suture annuloplasty that we have used successfully in 400 patients treated by Aortic Valve Repair.
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Aortic Valve Repair—Current Status, Indications, and Outcomes
Seminars in thoracic and cardiovascular surgery, 2012Co-Authors: Diana Aicher, Hansjoachim SchafersAbstract:Aortic Valve Repair is a new development with old roots. In the past 20 years, marked progress has been made in understanding the normal anatomy of the Aortic Valve and the interrelation between cusps and root. Aortic dilatation is the single most frequent pathogenetic factor in Aortic regurgitation, accompanied by cusp pathology, that is, prolapse or congenital anomaly in most industrialized countries. Frequently, Aortic and cusp pathology coexist. Different operative techniques have been established for correction of Aortic and cusp pathology. Experience has shown that the combined application of Repair procedures will lead to good results if normal Valve and cusp configuration is achieved. Some congenital anomalies may require design alteration of the Aortic Valve. Low-operative mortality rates have been reported consistently. When adequate Repair durability is achieved, the incidence of Valve-related complications is lower than what has been reported for Valve replacement. Aortic Valve Repair is currently in transition from surgical improvisation to a reproducible operation and an option for many patients with Aortic regurgitation. Current research focuses on some special aspects, such as stabilization of the basal ring, ideal material and technique for cusp replacement, and more objective information on ideal Valve configuration.
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Aortic Valve Repair leads to a low incidence of Valve-related complications
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2009Co-Authors: Diana Aicher, Frank Langer, Roland Fries, Svetlana Rodionycheva, Kathrin I Schmidt, Hansjoachim SchafersAbstract:Objective: Aortic Valve replacement for Aortic regurgitation (AR) has been established as a standard treatment but implies prosthesis-related complications. Aortic Valve Repair is an alternative approach, but its mid- to long-term results still need to be defined. Methods: Over a 12-year period, 640 patients underwent Aortic Valve Repair for regurgitation of a unicuspid (n = 21), bicuspid (n = 205), tricuspid (n = 411) or quadricuspid (n = 3) Aortic Valve. The mechanism of regurgitation involved prolapse (n = 469) or retraction (n = 20) of the cusps, and dilatation of the root (n = 323) or combined pathologies. Treatment consisted of cusp Repair (n = 529), root Repair (n = 323) or a combination of both (n = 208). The patients were followed clinically and echocardiographically; follow-up was complete in 98.5% (cumulative follow-up: 3035 patient years). Results: Hospital mortality was 3.4% in the total patient cohort and 0.8% for isolated Aortic Valve Repair. The incidences of thrombo-embolism (0.2% per patient per year) and endocarditis (0.16%per patient per year) were low. Freedom from re-operation at 5 and 10 years was 88% and 81% in bicuspid and 97% and 93% in tricuspid Aortic Valves (p = 0.0013). At re-operation, 13 out of 36 Valves could be re-Repaired. Freedom from Valve replacementwas95%and90%inbicuspidand97%and94%intricuspidAorticValves(p = 0.36).FreedomfromallValve-relatedcomplicationsat10 yearswas88%.Conclusions:Reconstructive surgeryoftheAorticValveis feasiblewithlowmortalityin manyindividualswith Aorticregurgitation. Freedom from Valve-related complications after Valve Repair seems superior compared to available data on standard Aortic Valve replacement. # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
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Aortic Valve Repair with autologous pericardial patch
European Journal of Cardio-Thoracic Surgery, 2006Co-Authors: Henning F Lausberg, Diana Aicher, Frank Langer, Hansjoachim SchafersAbstract:Introduction: Isolated Aortic Valve Repair (AVR) has been gaining increasing interest in recent times. Results of isolated Aortic Valve Repair have been reported to be variable. Various techniques have been utilized. We analyzed our experience with isolated Valve Repair using autologous pericardial patch plasty and compared the results to an age-matched collective with Aortic Valve Repair without the use of additional material. Methods: Between January 1997 and June 2005, pericardial patch plasty of the Aortic Valve was performed in 42 patients (PATCH). During the same period, 42 patients after AVR without the use of additional material were age matched (NO-PATCH). Mean age in both groups was 52 years with a majority of male patients (PATCH ratio, 3.7:1; NO-PATCH ratio, 5:1). Valve anatomy was similar in both groups. All patients were followed byechocardiographyfora cumulativefollow-upof2341patientmonths(mean28 23months).Results:Nopatientdiedinthehospitalinneither group. The average systolic gradient was 5.9 2.2 mmHg in PATCH and 4.8 2.1 mmHg in NO-PATCH; p = 0.17). Freedom from Aortic regurgitation II8 was 87.8% in PATCH and 95.0% in NO-PATCH after 5 years (p = 0.21). Freedom from reoperation was 97.6% in PATCH and 97.4% in NO-PATCH (p = 0.96). Conclusions: Aortic regurgitation can be treated effectively by Aortic Valve Repair using pericardial patch plasty. The functional results are satisfactory. With the application of this technique also more complex pathologies of the Aortic Valve can be addressed adequately thus extending the concept of Valve preservation in patients with Aortic regurgitation.
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Valve Repair in Aortic regurgitation without root dilatation--Aortic Valve Repair.
The Thoracic and cardiovascular surgeon, 2006Co-Authors: Henning F Lausberg, Diana Aicher, Frank Langer, A. Kissinger, R. Fries, Hansjoachim SchafersAbstract:Background Aortic Valve Repair was established in the context of Aortic root remodeling. Variable results have been reported for isolated Valve Repair. We analyzed our experience with isolated Valve Repair and compared the results with those of Aortic root remodeling. Methods Between October 1995 and August 2003, isolated Repair of the Aortic Valve was performed in 83 patients (REP), remodeling of the Aortic Valve in 175 patients (REMO). The demographics of the two groups were comparable (REP: mean age 54.4 +/- 20.7 yrs, male-female ratio 2.1 : 1; REMO: mean age 60.8 +/- 13.6 yrs, male-female ratio 2.4 : 1; p = ns). In both groups the number of bicuspid Valves was comparable (REP: 41 %, REMO: 32 %; p = ns). All patients were followed by echocardiography for a cumulative follow-up of 8204 patient months (mean 32 +/- 23 months). Results Overall in-hospital mortality was 2.4 % in REP and 4.6 % in REMO ( p = 0.62). Systolic gradients were comparable in both groups (REP: 5.8 +/- 2.2, REMO: 6.5 +/- 3.1 mm Hg, p = 0.09). The mean degree of Aortic regurgitation 12 months postoperatively was 0.8 +/- 0.7 after REP and 0.7 +/- 0.7 after REMO ( p = 0.29). Freedom from significant regurgitation (> or = II degrees ) after 5 years was 86 % in REP and 89 % in REMO ( p = 0.17). Freedom from re-operation after 5 years was 94.4 % in REP and 98.2 % in REMO ( p = 0.33). Conclusions Aortic regurgitation without concomitant root dilatation can be treated effectively by Aortic Valve Repair. The functional results are equivalent to those obtained with Valve-preserving root replacement. Aortic Valve Repair appears to be an alternative to Valve replacement in Aortic regurgitation.