Valve sparing aortic root surgery: from revolution to evolution?

Valve sparing aortic root replacement (VSRR) is lucrative option for young patients with aneurysmal disease involving the aortic root while the aortic valve (AV) itself is functionally intact and can be repaired. The benefits of retaining the native AV extends beyond those of avoiding the inconvenience and complications of prolonged exposure to anticoagulants. It includes delaying of need for reoperation related with valvular degeneration of prosthetic valves. Despite these advantages, performance of this procedure has been challenging due to its technical demand and complexity as well as requirement of experienced surgeon to perform the procedure. This review aims to outline the current literature on VSRR and the mid to long-term outcomes in both elective and emergency settings.