Aortic Valve Repair: The Functional Approach to Leaflet Prolapse and Valve-Sparing Surgery Hugues Jeanmart, MD, Laurent de Kerchove, MD, David Glineur,

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Aortic Valve Repair: The Functional Approach to Leaflet Prolapse and Valve-Sparing Surgery Hugues Jeanmart, MD, Laurent de Kerchove, MD, David Glineur, MD, Jean-Michel Goffinet, MD, Ishan Rougui, MD, Michel Van Dyck, MD, Philippe Noirhomme, MD, Gebrin El Khoury, MD The Annals of Thoracic Surgery Volume 83, Issue 2, Pages S746-S751 (February 2007) DOI: 10.1016/j.athoracsur.2006.10.089 Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 This schematic representation of the aortic root shows its external limitations. The dissection of the aortic wall must continue to the base of implantation of the noncoronary leaflet (NC). At the level of the left and right sinuses, the dissection is limited by the presence of the right ventricular outflow tract (RVOT). A deeper dissection at this portion is a risk for ventricular perforation. The Annals of Thoracic Surgery 2007 83, S746-S751DOI: (10.1016/j.athoracsur.2006.10.089) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The proximal line of suture reinforced with Teflon felt (arrow) has to follow the external limitation of the aortic root. (NC = noncoronary; LC = left coronary leaflet; RC = right coronary leaflet.) The Annals of Thoracic Surgery 2007 83, S746-S751DOI: (10.1016/j.athoracsur.2006.10.089) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 After measuring the height of the new sinotubular junction, the prosthesis is cut to respect the anatomy of the aortoventricular junction. (NC = noncoronary; RVOT, right ventricular outflow tract.) The Annals of Thoracic Surgery 2007 83, S746-S751DOI: (10.1016/j.athoracsur.2006.10.089) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (a) Kaplan-Meier overall actuarial survival. (b) Kaplan-Meier curve for freedom from recurrence of aortic regurgitation exceeding grade 2 or stenosis (including early and late recurrences). (c) Kaplan-Meier curve for freedom from mitral valve reoperation (including early and late reoperations). (Solid line, all population; dashed line, remodeling; dotted line, reimplantation, dash-dot line, aortic valve [AV] sparing with AV repair.) The Annals of Thoracic Surgery 2007 83, S746-S751DOI: (10.1016/j.athoracsur.2006.10.089) Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions