Aortic valve repair (AVr) has evolved into a reproducible surgical strategy for selected patients with aortic regurgitation (AR), offering preservation of native tissue, avoidance of prosthesis-related complications, and favorable long-term outcomes when performed at expert centers. This narrative review summarizes contemporary concepts, indications, preoperative imaging work-up, and procedure selection for AVr in tricuspid (TAV) and bicuspid (BAV) aortic valves, with an emphasis on functional mechanisms and standardized annular and root stabilization. Recent international guidelines and key surgical series and registries addressing aortic valve repair, valve-sparing root replacement (VSRR), annuloplasty strategies, and bicuspid repair techniques were reviewed. Modern AVr is anchored in mechanism-based diagnosis of AR, systematic correction of cusp pathology, and stabilization of the functional aortic annulus (FAA), including the virtual basal ring, sinotubular junction, and aortic root. Current guideline recommendations support aortic valve repair in selected patients with severe AR at experienced centers when durable results are expected and recommend valve-sparing root replacement in young patients with aortic root dilation. Quantitative intraoperative quality control, including effective height targets, and durable annular stabilization are key determinants of repair longevity. AVr and VSRR represent mature surgical options for carefully selected patients with AR, particularly younger individuals with good cusp tissue and access to high-volume repair expertise. A mechanism-driven algorithm, including BAV-specific geometry restoration approaches such as the 180-degree reimplantation technique, may clarify the optimal procedure for each clinical scenario.
Łukasz Jaworski, S. Beta, Maria Nowak et al.· Cardiology Journal· 0 citations
BACKGROUND
Coronary computed tomography angiography (CCTA) reported with Coronary Artery Disease Reporting and Data System (CAD-RADS) 2.0 is increasingly used in chronic coronary syndromes, but real-world adherence to the recommended downstream pathways is poorly characterized.
AIMS
To describe the population referred for CCTA in a Polish tertiary center, the distribution of CAD-RADS 2.0 categories by sex and age, and adherence to guideline-recommended downstream pathways.
METHODS
We retrospectively analyzed 10 005 consecutive patients who underwent CCTA between July 1, 2022 and December 31, 2024. Downstream procedures were identified in the National Health Fund registry. A pre-specified multivariable logistic regression model (CAD-RADS category, age, sex) described referral for invasive coronary angiography (ICA); discrimination was quantified as the area under the receiver-operating-characteristic curve (AUC).
RESULTS
Women constituted 57.8% of the cohort and were older than men (mean 66.4 vs. 64.1 years; P < 0.001). The distribution of categories differed by sex (P < 0.001). Among patients with CAD-RADS 0-2, 18.5% underwent at least one additional test. Among patients with CAD-RADS 3, 41.8% proceeded directly to ICA without prior functional testing and 17.7% followed a functional-testing-first pathway. Among patients with CAD-RADS 4-5, 26.0% did not undergo ICA and 17.8% had no further testing. CAD-RADS category dominated referral for ICA (full model AUC 0.886; 95% confidence interval, 0.877-0.894; CAD-RADS alone 0.883; age and sex alone 0.677).
CONCLUSIONS
Divergence between observed and guideline-recommended pathways was evident across all CAD-RADS categories, indicating a need for structured implementation of CAD-RADS-guided care pathways.
Jadwiga Fijałkowska, K. Sienkiewicz, Dorota Gałąska et al.· Kardiologia polska· 0 citations
