[Aortic valve sparing for aortic root aneurysm in patients with Marfan syndrome].

Forteza et al from the Hospital Universitario 12 de Octubre described in this issue of the Revista Española de Cardiología their initial experience with aortic valve sparing operations for aortic root aneurysm in 18 patients with Marfan syndrome. The authors indicated that they have done 40 such operations for aortic root aneurysm. The early results reported are excellent and I commend them for introducing this type of conservative valve surgery in their cardiac unit. I have no doubt that in selected patients valve repair provides better clinical outcomes than valve replacement. Aortic valve sparing operations are complicated procedures because they require exceptional knowledge of the functional anatomy of the aortic valve as well as technical expertise. They are not easily reproducible. There are basically two types of aortic valve sparing operations to treat aortic root aneurysm: reimplantation of the aortic valve and remodeling of the aortic root. Figures 1, 2, and 3 show sketches of these operations. Remodeling of the aortic root is a physiologically sounder procedure than reimplantion of the aortic valve but we have shown in patients with Marfan syndrome that the aorto-ventricular junction continues to dilate after remodeling of the aortic root and eventually aortic insufficiency ensues. For this reason, we believe that reimplantation of the aortic valve is more appropriate to treat young patients with aortic root aneurysm whether they have the Marfan syndrome or not. Since the introduction of reimplantation of the aortic valve to treat aortic root aneurysms, several technical modifications have been proposed. Most of these changes have focused on creating neo-aortic sinuses to reduce the velocity of closure of the aortic cusps to Aortic Valve Sparing for Aortic Root Aneurysm in Patients With Marfan Syndrome