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Prospective surgical strategies for type 1 A aortic insufficiency
Journal article   Open access   Peer reviewed

Prospective surgical strategies for type 1 A aortic insufficiency

Aryan Meknat, Alee N. Pettit, Neusha Hollingsworth and Michael S. Halbreiner
CARDIOTHORACIC SURGEON, v 33(1), 20
01 Dec 2025
DOI: https://doi.org/10.1186/s43057-025-00165-1
url
https://doi.org/10.1186/s43057-025-00165-1View
Published, Version of Record (VoR) Open

Abstract

Cardiac & Cardiovascular Systems Cardiovascular System & Cardiology Life Sciences & Biomedicine Science & Technology
BackgroundThe El-Khoury's classification of aortic insufficiency mirrors the well-established Carpentier's classification for mitral insufficiency but takes the classification schema a step further by subcategorizing type 1 AI. At most centers, even high-volume aortic centers, any root pathology with associated aortic valve disease is treated with concomitant root and aortic valve replacement with a valved conduit. The focus of this review is to highlight which valve-sparing root procedures could be best applied to specific root pathologies with associated AI, as a potential procedural algorithm. Main bodyFor type 1a AI-normal appearing cusps with STJ dilation and type 1c AI-normal appearing cusps with isolated annular dilation (i.e., annuloaortic ectasia), the Florida Sleeve procedure is a viable option. For type 1b AI-normal appearing cusps with sinus and STJ dilation, the well-established valve sparing root remodeling and reimplantation techniques have been described as an effective option to re-establish aortic valve function. Ultimately, the root procedure performed for patients with AI needs to be tailored to the patient's pathology and what's feasible. If upon inspection there is a calcified annulus or cusps, or prolapsed or restricted cusp-a modified Bentall procedure is still a durable and viable option, especially at centers not well versed in aortic valve repair. Conclusions With a greater understanding of root anatomy, function, and pathology (i.e., type 1 AI), the optimal procedure can be performed for a patient based on their goals and with consideration for their risk profile.

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