Isolated aortic valve repair—how to do it and long-term results: external ring annuloplasty

The growing expertise in valve sparing root replacement over the years (1) has paved the way for developing isolated aortic valve (AV) leaflet repair as an alternative to replacement, especially when a standardized systematic approach in term of annulus and sinotubular junction (STJ) stabilization is utilized. Since 2003, we have developed a standardized systematic approach for AV repair which incorporates leaflet repair and the stabilization of annulus and STJ with double sub and supra (STJ) valvular external ring annuloplasties (Figure 1)