Course 5: Aortic Root Enlarging Procedures and Aortic Valve Leaflet Reconstruction

Course Directors: S. Adil Husain, San Antonio, TX, and Prashanth Vallabhajosyula, Philadelphia, PA


This course will review two specialized subareas of technical expertise required in the context to complex aortic root surgery.  It will review the anatomic approaches and surgical techniques employed in performing aortic root enlarging procedures as well as aortic valve leaflet reconstructive techniques and the importance of providing annular stabilization in the context of a repaired aortic valve.  Surgical strategies for root enlargement to be addressed will include Nicks, Manougian, and the Ross Konno.  Surgical techniques involving aortic valve leaflet reconstruction will include primary simple cusp plication techniques, patch augmentation technique, Goretex free margin shortening technique, and orienting repaired bicuspid aortic valve into its aortic neoroot.

Learning Objectives
Upon completion of this activity, participants should be able to:

  • Identify the anatomy and appropriate surgical landmarks in the left ventricular outflow tract and aortic valve apparatus
  • Describe the incision sites and overall surgical techniques for a variety of root enlargement strategies
  • Discuss surgical pitfalls associated with each strategy and mechanisms by which to delineate options based upon patient and anatomic substrate
  • Describe how to set up and expose the aortic root for primary valve repair and identify the risk factors for repair failure based on the anatomy of the aortic valve
  • Recall the different aortic annual stabilization techniques and recognize the impact of each technique on valve repair - subcommissural annuloplasty, external aortic ring, and root reimplantation
  • Identify different bicuspid aortic valve types and explain the implications for valve repair and the choice of annular stabilization
  • Demonstrate how to implant a type I bicuspid aortic valve in the context of its neoroot – what do the different bicuspid subtypes mean for orienting the repaired valve when performing a root reimplantation.

Please watch the video below containing background information and lecture materials associated with this course.

Please note: No CME credit is associated with the viewing of web-based content. This presentation was created for The Society of Thoracic Surgeons STS University courses, and STS retains sole rights to these materials.