Aortic Surgery 
Valve Analysis for Patients with Aortic Root Aneurysms
When a patient has an aneurysm of the aortic root, the aortic valve may also be damaged. Depending on how well the valve is functioning, it may need to be replaced or repaired when the aortic root aneurysm is repaired.
As has been shown previously with mitral valve replacement, the use of artificial valves is a lifesaving advance. Animal valves have a finite life span (approximately 15 years for most), and mechanical valves require life-long anticoagulation medication. or these reasons, repair is attempted whenever possible.
In the appropriate patient, preservation of the valve may provide longer symptom-free survival and reduced need for re-operation, as long as repairs can be achieved perfectly with no leakage. Thus the question of whether to repair or replace the aortic valve requires very careful consideration.
Our consideration of valve repair begins with examination of the valve on echocardiogram: is it normal? Does it leak? Are the leaflets stuck? Are there holes (fenestrations) in the leaflets? Are there two leaflets or three?
If the aortic valve appears normal, repair may be possible. We then carefully examine the valve at the time of surgery. Time is spent in evaluating the integrity of the leaflets, how they touch one another, and how they relate to the base of the heart. If, after this detailed analysis, we believe a repair is indicated, then we will perform a valve-sparing procedure. If the aortic valve is stenotic or calcified, we must determine whether the area of damage is restricted to one area, in which case it still may be rebuilt. However if the damage is widespread enough that it will require replacement, there is little value in performing an inadequate repair.
For more, read about intraoperative assessment of repair
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