title: Cusp repair during aortic valve-sparing operation: technical aspects and impact on results.
abstract: OBJECTIVE
  Aortic valve-sparing operations are nowadays considered safe and reliable procedures in terms of mid-term and long-term results. Although surgical techniques regarding the modality of grafts' implantation have been properly addressed, the modality of cusp repair, when needed, is still open to debate. We sought to review the literature to try to shed light on when the cusp repair is required and how it should be performed.
  
  
  METHODS
  We searched the PubMed database using the keywords aortic valve-sparing operation, aortic valve-sparing reimplantation, valve-sparing aortic root replacement, aortic valve repair, and aortic cusp repair. Only studies that included and described in detail the technique of cusp repairs in adjunct to aortic valve-sparing operation were considered.
  
  
  RESULTS
  Bicuspid aortic valve more often requires correction when compared with tricuspid valve. The range of the techniques varies from the 'simple' free margin plication to the more complex triangular resection with patch repair. Results in the literature seem to be encouraging, showing that, in most of the cases, cusp repair does not affect valve competence in the mid-term and long-term.
  
  
  CONCLUSIONS
  Correction of the cusp is a delicate balance between undercorrection that could lead to residual prolapse and overcorrection that could lead to cusp restriction. Although complex repair of the aortic valve in addition to root replacement provided satisfactory results, it should be reserved for experienced centers with a large volume of patients.
authors: Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors: Fabrizio
authors: F
authors: Settepani
authors: Antioco
authors: A
authors: Cappai
authors: Giuseppe M
authors: GM
authors: Raffa
authors: Alessio
authors: A
authors: Basciu
authors: Alessandro
authors: A
authors: Barbone
authors: Daniele
authors: D
authors: Berwick
authors: Enrico
authors: E
authors: Citterio
authors: Diego
authors: D
authors: Ornaghi
authors: Giuseppe
authors: G
authors: Tarelli
authors: Pietro G
authors: PG
authors: Malvindi
mesh_terms: D001021:Aortic Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D017548:Echocardiography, Transesophageal; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome