Purpose of Review

Preservation or repair of the aortic valve has evolved dynamically in the past 20 years. It leads to a high freedom from valve-related complications if an adequate valve durability can be achieved; it may possibly also improve survival. To date, little structured information is available about which valves can be repaired and which should better be replaced.

Recent Findings

For surgical decision-making, the size of the aortic root is important and the anatomy of the aortic valve must be considered. In the presence of root aneurysm, most tricuspid and bicuspid aortic valves can be preserved. In aortic regurgitation and normal aortic dimensions, the majority of tricuspid and bicuspid aortic valves can be repaired with good long-term durability. In bicuspid aortic valves, the morphologic characteristics must be taken into consideration. Unicuspid and quadricuspid aortic valves can be repaired in selected cases. Generally, cusp calcification is a sign of a poor substrate for repair; the same is true for cusp retraction and cusp destruction due to active endocarditis. They are associated with limited valve durability.

Summary

Using current concepts, many non-calcified aortic valves can be repaired. Modern imaging, in particular three-dimensional transesophageal echocardiography (TEE), should be able to define repairable aortic valves with a high probability.

中文翻译：

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哪种主动脉瓣可以通过手术重建？

审查目的

在过去的 20 年中，主动脉瓣的保存或修复不断发展。如果可以实现足够的瓣膜耐用性，则可以避免与瓣膜相关的并发症；它还可能提高生存率。迄今为止，关于哪些阀门可以维修以及哪些应该更好地更换的结构化信息很少。

最近的发现

对于手术决策，主动脉根部的大小很重要，必须考虑主动脉瓣的解剖结构。在存在根部动脉瘤的情况下，可以保留大多数三尖瓣和二尖瓣主动脉瓣。在主动脉瓣关闭不全和主动脉瓣尺寸正常的情况下，大部分三尖瓣和二尖瓣主动脉瓣都可以修复并具有良好的长期耐用性。在二叶主动脉瓣中，必须考虑形态特征。在某些情况下可以修复单尖瓣和四尖瓣主动脉瓣。一般来说，牙尖钙化是修复基质不良的标志；活动性心内膜炎引起的瓣叶回缩和瓣叶破坏也是如此。它们与有限的阀门耐用性有关。

概括

使用当前的概念，可以修复许多未钙化的主动脉瓣。现代成像，尤其是三维经食道超声心动图 (TEE)，应该能够以很高的概率确定可修复的主动脉瓣。