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The following is a summary of “A new guiding strategy for treating the free margin of the leaflet in an aortic root remodelling procedure,” published in the March 2025 issue of the Journal of Cardiothoracic Surgery by Luo et al.

Valve-sparing aortic root replacement procedures necessitate precise correction of leaflet prolapse to ensure optimal valve function and long-term durability. This correction is typically achieved by shortening the free margin of the leaflet, yet determining the exact degree of reduction remains a critical challenge. This study aims to evaluate the efficacy of a guiding strategy for managing the free margin length during a modified aortic root remodeling procedure incorporating an external sub-valvular ring. 

Between January 2021 and May 2024, a total of 12 patients (10 males and 2 females) with aortic root aneurysms underwent this modified surgical approach. The mean patient age was 42 ± 14 years. The diameter of the graft was determined based on the Lansac group’s criteria, which utilize the aortic annulus diameter as a reference. Free margin correction was performed through central plication, following a standardized approach in which the target length of the free margin was set to the diameter of the selected graft plus 3–5 mm. The surgical procedure was successfully completed in all 12 patients, with no perioperative mortality or major complications. Free margin central plication was required to varying extents: four patients underwent correction of all three leaflets, two patients required correction of two leaflets, three patients had correction of a single leaflet, and three patients did not require any adjustment of the free margin. 

Postoperative echocardiographic evaluation confirmed that no patient exhibited more than mild residual aortic regurgitation. Following aortic root reconstruction, the measured effective height and coaptation length were 8.9 ± 1.3 mm and 5.3 ± 0.9 mm, respectively, indicating adequate valve competence. These findings suggest that the proposed guiding strategy, which utilizes graft diameter as a reference, provides a reliable method for standardizing free margin adjustments during aortic root remodeling with an external sub-valvular ring. By ensuring precise correction of leaflet prolapse, this approach enhances valve function and may contribute to improved long-term outcomes in patients undergoing valve-sparing aortic root replacement.

Source: cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-025-03392-z