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Editorial comment

Department of Cardiac Surgery, Brussels University Hospital St. Luc, Brussels B-1120, Belgium

^_* Corresponding author. (Email: elkhoury@chir.ucl.ac.be).

The first 20% of the full text of this article appears below.

	1. Introduction

 
Aortic repair surgery has gained a wider interest in the last 15 years; several publications showing short- and long-term results support this trend. A brief analysis of indications and aetiology can give us an idea as to which forms of aortic regurgitation are amenable to successful repair. Originally, aortic repair was only performed in case of rheumatic or calcific aortic regurgitation, which explains the poor results.

Because of the near disappearance of rheumatic disease in younger patients, other congenital and/or degenerative aetiologies have become more frequent indications for conservative aortic surgery. Thus, bicuspid aortic valve, degenerative diseases of the media (as Marfan syndrome), degenerative cusp prolapse and acute aortic dissection are nowadays the most common mechanisms of aortic insufficiency that can lead to conservative aortic surgery. Atherosclerotic aortic aneurysm of ascending aorta is another indication in elderly patients. Endocarditis of the aortic valve, acute or chronic, is a less favourable indication, contrary to what happens in the mitral valve. One common characteristic of the indications previously enlisted is the good quality of valvular tissue.

Although several surgical techniques have been published for treating different aortic lesions, it is rather impossible to draw any valid conclusions regarding the feasibility of aortic repair or the choice of the most appropriate technique. Actually in literature we still need a complete review of surgical results, with an overall analysis of recurrences and surgical failures. We do have to change our approach for a better understanding of this disease. How?

First of all we have to define the aetiologic and pathogenic mechanisms of aortic regurgitation, to propose a complete classification based on these mechanisms, and to describe several appropriate surgical techniques. This classification should have aetiologic, clinical and . . . [Full Text of this Article]