Aortic Surgery 
Intraoperative Assessment
Aortic Valve Repair or Replacement?
The decision whether to repair or replace the aortic valve begins during the first office consultation. The first appointment often leads to the surgeon listening to the patient's chest and examination by echocardiography. The surgeon views the results together with the patient, at which time the possibility of repair is discussed.
Factors that affect the decision include:
- the presence of significant calcium on the valve;
- the presence of connective tissue disorders with more than one leaflet prolapsing;
- significant fenestration of the valve; or
- progressive leaflet deterioration.
Advanced age is not a factor, as successful valve repair may be performed in patients over 80.
Safety of Valve-sparing Aortic Root Surgery in Septuagenarians and Octogenarians.
At the time of surgery, transesophageal echocardiography (TEE) provides good three-dimensional imaging of the valve and helps to guide the surgeon. Once the aorta is visible, then final decision can be made to either repair or replace the aortic valve. The most important determinant is whether a repaired valve will last longer than a prosthetic.
In assessing the valve, the surgeon looks at its appearance. We ask several questions to make an informed, evidence-based decision. Is there a broken leaflet? Is it normal in appearance, or not? Is it bicuspid (abnormal) or tricuspid (normal)? If it is bicuspid, is the orifice large enough to repair any stenosis? Is the valve leaking at all? Extensive repair to achieve normal functioning may not be in the patient's best interest, but if the defect is correctable, then it may be worth doing.
The Aortic Surgery Program at NYPH/Columbia has never had a failure in repair once the repair has been performed.
