Surgical reconstruction (repair) of diseased heart valves is the best operative solution. The possibility of aortic valve reconstruction mainly depends on the type of aortic valve disease as well as the condition of the leaflets. Aortic valve reconstruction is also applied for aortic valve failure (insufficiency), unlike aortic stenosis when it is very rarely performed. If the leaflets are thin, mobile, with smooth free edges, the reconstructive surgery is highly likely to be performed, including even a bicuspid aortic valve. Reconstructive surgery of the aortic valve can be divided into: a) a procedure performed only on the valve and b) a procedure performed as a part of the diseased ascending thoracic aorta which causes aortic insufficiency.
The procedure on the very aortic valve leaflets is performed due to: the existence of a defect – perforated leaflet (after cured infectious endocarditis, after the leaflet tumor resection – papillary fibroelastoma) or leaflet prolapse. Dilatation of the ascending aorta (aortic aneurysm) can affect the anatomy of the aortic valve and lead to aortic insufficiency. In case of this disease, it is possible to perform Tyrone David and Yacoub procedure, where the ascending aorta is replaced, and the aortic valve is reconstructed so that the patient does not have an artificial valve after these procedures and does not have to take anticoagulant therapy. Tyrone David procedure has proven to be a better option in younger patients with congenital connective tissue diseases (e.g., Marfan syndrome). The durability of these reconstructed aortic valves during 15-year follow-up period is up to 98%. A more recent reconstructive procedure, Ozaki procedure, is performed on a stenotic aortic valve. During this procedure, special technique is used to recreate new leaflets from the patient’s pericardium, which replaces severely modified (calcified) lesions. Future studies and long-term monitoring should confirm the effectiveness of this technique. Such reconstructive procedures of the ascending aorta and aortic valve represent an ideal treatment, especially in younger patients. However, these are extremely technically demanding and time-consuming procedures that can be performed only by surgeons with extensive experience in this field.