Valve sparing root replacement: remodeling root repair with aortic ring annuloplasty

Recent international guidelines on the management of aortic root disease mention “aortic annuloplasty” in combination with aortic root remodeling as part of a class I indication for management of aortic root aneurysm (1). The remodeling technique provides physiological cusp movement within three reconstructed neo-sinuses, which permits root expansibility through the interleaflet triangles. We have developed a standardized aortic valve and root repair protocol involving a physiological reconstruction of the aortic root using the remodeling technique, cusp effective height resuspension, and a subvalvular external aortic ring annuloplasty (Figure 1)