PRO-CON debate: valve sparing aortic root surgery. PRO: reimplantation.

The remodeling and the reimplantation procedures were described more than 25 years ago with the aim of sparing, otherwise normal aortic valve in the presence of a root aneurysm. Because of its ability to reconstruct the sinuses of Valsalva, the remodeling procedure was considered to be more physiological than the reimplantation. However, because the remodeling lacked annular stabilization, the long-term stability of the procedure was questioned. However, through the years, both procedures have been significantly improved, so that is now possible to perform a reimplantation procedure with neo-sinuses reconstruction or a remodeling procedure with annular stabilization. In this way, both procedures can now guarantee an anatomical root reconstruction and an increased long-term durability. Today preference for a reimplantation procedure is based on the perception of a better reproducibility of the surgical procedure, an increased procedural safety due to the characteristic hemostatic feature of this surgical approach, and to a much larger amount of data present in the literature on long-term results.