Contemporary surgical management of aortic valve disease: From replacement to reconstruction

Aortic valve pathology remains one of the most common causes of cardiovascular morbidity and mortality. Our current understanding of aortic valve disease has changed significantly in recent decades due to advances in imaging techniques, refinements in surgical technologies, and the emergence of reconstructive and transcatheter approaches. Currently, aortic valve treatment encompasses a wide range of interventions, from classic valve replacement to reconstructive surgery, valve-sparing procedures, the Ross procedure, aortic neocuspidization (AVNeo/Ozaki procedure), and transcatheter valve implantation (TAVI). The modern concept of the aortic valve considers it to be part of a functional aortic complex, including the leaflets, annulus fibrosus, commissures, sinuses of Valsalva, sinotubular junction, and ascending aorta. The development of repair-oriented surgery has significantly expanded the possibilities for preserving the native valve, especially in young patients and those with a bicuspid aortic valve. Of particular importance are issues of intervention durability, lifetime management, prevention of prosthesis-patient mismatch, and individualized treatment strategy. This review presents current data on the anatomy, pathophysiology, imaging, and surgical treatment of aortic valve disease, with a particular emphasis on reconstructive surgery, bicuspid aortic valve surgery, AVNeo, valve-sparing procedures, and modern transcatheter technologies.