Penn Aorta Center Co-director Joseph Bavaria, MD, discusses the aortic valve repair program at Penn Medicine. He reviews three major areas of the aortic valve insufficiency and aortic valve repair paradigm: aortic valve sparing procedures, bicuspid aortic valve repair, and three-cusp aortic valve repair. He also reviews the recent European and American guidelines.
Related Links: See Dr. Bavaria's physician profile Hello. My name is joseph bavaria and I'd like to spend a few minutes talking about the aortic valve repair program at the University of pennsylvania as a as a wrap up to the previous discussions. So this is the wrap up and the first one. The first concept is to look at aortic valve sparing procedures. And this is what this looks like where you have a normal, fairly normal aortic valve. You have a root aneurysm. And as you can see in these pictures, the valves are beautiful and it would be very, very shameful to do a root procedure where you're replacing this aortic valve, which is a totally normal aortic valve with either a tissue valve or a mechanical valve. And this is what what these different kind of operations in two different patients look like. But the key concept is to understand what we're trying to achieve here, which is repair of the aneurysm of the root, but retention of a fairly normal aortic valve, which is probably regurgitation secondary to the aorta and not primary to the valve itself. The second big area of the, of the valve repaired of a paradigm. Uh And this wrap up is the bicuspid aortic valve repaired. And in this particular case there is a root aneurysm that doesn't have to be an aneurysm and what you can see is a highly redundant aortic valve on the conjoined leaflet here and then we're doing a publication stitch. And when we're done you can see that we have nice good motion of this black history aortic valve. Uh And uh we have a nice good motion of the aortic valve uh and we have a very very uh solid valve repair here with good co optation zone, as you can see good, good equality of the co optation zones. So this is a bicuspid aortic valve repair paradigm. Now, when it comes to bike to three custom aortic valve repair, uh this is an example of a dissection case where we're actually having a fairly normal three cusp aortic valve and we're basically doing a route reconstruction here root repair to save this valve and this is what about what it looks like in real life. Uh And the other big presentation besides the order dissection which requires three custody order valve repair is a prolapsed valve. And you can see if we have a right corner really fit right in this middle picture here that has prolapsed, we can just do a simple application, make the free margin of the right leaflet the same as the left and the non and that's a three custody order valve repair. Now, the what I just showed you was was the the paradigm of the three major, you know, uh presentations of aortic valve insufficiency uh And uh aortic valve repair here's the last thing which is that um the concept of the aortic valve repair as well as valve sparing aortic root replacement valve sparing aortic root surgery has have made it to the guidelines. They've made it to the to the aortic guidelines as well as the value of guidelines. And here you can see the european guidelines. Uh aortic valve repair using re implantation technique is recommended in young patients with aortic root dilation And try customer valves when they performed by experienced service. This is in the European guidelines of 2017. This is the order guidelines. Now the Valvular guidelines of 2021 just in January 2020 in Europe, also show the same thing. Aortic valve repair may be considered in selected patients that experienced centers when durable results are expected. Now this is a to be indication in the valve guidelines but the valve sparing operation is actually a level uh level one or class one indication. Uh and gets back into my original pictures which I just showed you which is if you have a nice normal or near normal aortic valve you have a root aneurysm. Uh you should really repair those valves and spare those valves. Which is the key word now it's also received uh you know mentioned in the american guidelines as well. This is the most recent fabulous guidelines coming out of the american Heart association in A. C. C. And you can see that in this particular case in patients with B. A. V. And severe aortic regurgitation who meet criteria for a br aortic valve repair may be considered selected patients. It performed at a comprehensive valve center. So this is actually another to be indication as well. So both the european american guidelines have recognized the advances, uh the significant advances in aortic valve repair over the past decade. So the big stick is that the aortic valve repair and valve sparing operations have made it into the recent H. A. And E. S. C. Guidelines, uh in both valve and aortic guidelines. And this is very, very important. Thank you very much.