Abstract
Repair of the bicuspid aortic valve has received much attention in the past 20 years. Less has been published on tricuspid aortic valve repair, even though tricuspid morphology accounts for w60% of regurgitant aortic valves.
Repair of the aortic valve must consider its condition as a functional unit, with form and function being determined by root and cusps. Schematically, the valve can be defined through annular and sinutubular diameter, commissural height, and geometric cusp height (gH) (Figure 1). Cusp configuration can be quantified through its effective height (eH) (Figure 1).1
Annular and sinutubular dilatation impair valve coaptation, leading or contributing to regurgitation.2 Cusp pathology-prolapse being the most frequent-is common in root dilatation and the main cause of regurgitation with normal aortic dimensions.3 More durable repair results can be obtained with repair of cusp prolapse compared with retraction.4
In general, repair consists of correcting the mechanisms that cause or contribute to aortic regurgitation (AR). Analysis of the underlying mechanism is an essential component of the repair to generate an individualized plan. In Figure 2, we propose an algorithm for decision making in tricuspid aortic valve repair. This is based on precise echocardiographic and intraoperative morphologic analysis, which should be part of the surgical training. Established techniques can then be applied to correct the existent pathology. Depending on the patient's age and characteristics, durability of repair should be weighed against the disadvantages of replacing the valve.