How geometry drives innovation in aortic valve repair

Understanding the geometry and thus the possibility of repairing the aortic valve (AV) has evolved over time thanks to the integration of historical insights and technological advances. The aortic root geometry has proven to be central to understanding valve function. Today with modern finite element models and flow studies, supported by four-dimensional magnetic resonance imaging, we have provided a better understanding of the importance of the sinuses of Valsalva in blood flow dynamics, confirming that the presence of sinuses reduces cusp stress and improves repair durability, promoting the adoption of valve prostheses with incorporated sinuses. Looking to the future, the scientific community must push towards a better fusion of currently available technologies to address aortic valve repair towards personalizing procedures to fit the unique anatomy of each patient using new technologies and even artificial intelligence to provide personalized surgical simulations. The goal is to make techniques more standardized, reproducible and accessible, while maintaining flexibility to address anatomical variability. Additionally, new materials and tools are being explored to further improve outcomes.