Aortic valve regurgitation. New era of reconstruction

Background. Surgical treatment of aortic valve insufficiency (AI) is evolving from prosthetic valve replacement towards valve sparing techniques. Extensive biodynamic and morphologic knowledge of the structures involved, highly individualized patient selection, and mastering of current techniques are mandatory to achieve durable and satisfactory results. Objective. Review of current guidelines. Which patients benefit from valve sparing surgery (VSS)? Survey of current surgical strategies. Methods. Review and discussion of the recent literature and discussion of expert recommendations. Results. Game changers, such as the concept of "effective height" and the development of step-by-step strategies have increased the reproducibility and improved the quality of VSS. Therefore, more surgeons are able to implement those techniques and spread its use. The currently available 10-year reoperation rates are encouraging. Current guidelines already advocate VSS for certain aortic valve alterations under the condition that the intervention is performed in specialized centers. Conclusion. Prosthetic valve replacement in all cases of AI is an obsolete concept. The currently implemented techniques, devices and concepts are performing well. Upcoming innovations will further improve the results in the future and reconstruction will become the most important treatment option for AI.