Aortic Root Surgery: The Biological Solution

The surgical results of bioprosthetic aortic valve replacement in the 1960s and 1970s were not very satisfactory. The search for the ideal substitute for the diseased aortic valve led Donald Ross to develop the concept of the aortic allograft in 1962 and the pulmonary autograft in 1967 for subcoronary implantation, and later, in 1972, as a full root for replacing the aortic root in the infected aortic valve with a root abscess. The aortic al- graft and pulmonary autograft surgical procedures were revo- tionary in the history of cardiac valve surgery in the last m- lennium because they compete well with the bioprosthesis, are nonthrombogenic (thus, requiring no postoperative anticoa- lation), are resistant to infection, restore the anatomic units of the aortic or pulmonary outflow tract, and offer unimpeded blood flow and excellent hemodynamics, giving patients a b- ter prognosis and quality of life. Surgery for congenital, degenerative, and inflammatory aortic valve and root diseases has now reached a high level of maturity; yet an ideal valve for valve replacement is not available. The- fore, surgeons are focusing their skills and their clinical and s- entific knowledge on optimizing the technical artistry of val- sparing procedures.