Current Treatment of Aortic Regurgitation. 1st ed. by Hans-Joachim Schäfers (ed.). London/Boston: UNI-MED Verlag Bremen; 2013. ISBN: 978–3-8374–1406–6 (Germany)/978–1-84815–196–3 (ROW)

Heart valves with isolated regurgitation can be repaired in the majority of cases. Reconstructive heart valve surgery therefore plays a major role in the current armamentarium of cardiac surgeons. Standardized techniques are well known with regard to mitral valve repair. However, standardized techniques of aortic valve repair seem to be less adopted. In the majority of cases, regurgitant aortic valves are still replaced, most commonly because of the intricate three-dimensional structure of the aortic root and the complexity of interaction of aortic root structures during the cardiac cycle. A systematic presentation of all relevant aspects important for the modern-day treatment of aortic valve regurgitation will increase our knowledge and acceptance to preserve the native aortic valve using reconstructive techniques.

The textbook “Current Treatment of Aortic Regurgitation” fills this gap in knowledge. Initially, a detailed anatomical description of the aortic valve is presented. Various underlying pathologies of aortic valve regurgitation are illustrated with detailed photos. The reader is informed about the current guidelines for the treatment of patients with aortic valve regurgitation. Besides medical treatment, the value of echocardiography is addressed with regard to preoperative decision making and postoperative evaluation of the operative procedures.

This book specifically focuses on the description of different operative techniques to treat aortic valve regurgitation. These include repair of isolated aortic valve/root structures and/or aortic valve preserving techniques in the presence of aneurysmatic disease. Besides aortic valve replacement using different types of valves, not only is the classical Bentall procedure described but the value of the Ross procedure in patients with aortic valve regurgitation is also mentioned. Technical aspects and long-term data with special focus on thromboembolic and anticoagulation-related hemorrhagic complications as well as the rates of reoperation are presented. These data will help surgeons in decision making with regard to the operative strategy to be used.

Details of reconstructive techniques are also presented in this book, with special focus on repair methods of individual aortic valve structures. These procedures are not often performed, either because the valve cannot be adequately exposed or the surgeon does not possess the experience to judge the underlying pathology. Some surgeons are not aware of the principles of reconstructive surgery and hence refrain from these procedures.

Aortic valve preserving techniques (reimplantation and remodeling) are also illustrated with intra-operative photos. The reader is guided through these operations in a systematic manner. Every chapter describing an operative procedure also contains the long-term outcome and underlines its value.

Computer-simulated imaging is addressed in a additional chapter. Hereby, the reader will understand the basic principles and aims of aortic valve reconstruction techniques and their implications for long-term valve performance.

Finally, long-term data are again summarized in an separate chapter. This will help surgeon and patient in choosing the appropriate technique or valve type. Various colleagues with known expertise in different fields of heart valve surgery have contributed to this book. This has aided to present a broad view on treating patients with aortic valve regurgitation.

In the majority of cases, aortic valves with isolated regurgitation can be repaired. These valves are often replaced due to lack of expertise in the analysis of the underlying pathophysiology and/or the knowledge of appropriate repair techniques. In addition, availability of very good long-term data on prosthetic valve substitutes supports replacement. This book gives the reader a broad overview of various aspects of isolated aortic valve regurgitation, thereby enriching the knowledge of cardiac surgeons about this very interesting aspect of aortic valve pathology.