Antonio F. Corno, MD, FRCS, FETCS, FACC, is Consultant Pediatric and Congenital Cardiac Surgeon at the East Midlands Congenital Heart Center, University Hospitals of Leicester, in Glenfield, Leicester, U.K.
He obtained his Privat-Docent (PhD equivalent) at University of Lausanne, Switzerland, and became Senior Lecturer in University of Liverpool, UK, then Professor of Pediatric Cardiac Surgery, University Sains Malaysia. Antonio F. Corno has more than thirty years’ experience with extensive clinical practice, scientific activity, experimental and clinical research, with authorship of 6 books and 12 chapters for books, 200 publications on peer-reviewed journals, and invited lectures wordlwide.
He has large experience in establishing new programs of pediatric and congenital heart surgery, as well as designing experimental research studies for new surgical techniques and clinical devices
Statement of the problem: The conventional surgery for aortic valve diseases was valve replacement with either biological or mechanical prosthesis, or autotransplantation of the pulmonary valve in aortic position (= Ross procedure). Aortic valve repair was generally limited to commissurotomy to relieve valve stenosis and commissurae and/or leaflets resuspension to reduce the degree of regurgitation. In the last decade several research studies have investigated the morphology of the aortic valve and the structure of its leaflets, while mathematical models combined with computational fluid dynamics revealed the functioning of the aortic valve and its root. In the same time sophisticated research facilities have been studying various biological and bio-engineered materials to replace the aortic valve leaflets. The new knowledge derived from all the above studies allowed the surgeons to perform in vivo evaluations of new techniques of aortic valve repair, followed by experimental studies on animals before moving to the clinical trials.
Methodology and theoretical orientation: The first surgical procedure introduced to repair aortic valve was the mobilization and extension of the three leaflets with strips of various materials. The suboptimal long-term results obtained with this technique prompted the surgeons to look for alternative approaches.
Two different techniques have been used: the replacement of a single aortic valve leaflet, and the replacement of all three ortic valve leaflets (Ozaki procedure). For the success of both this types of aortic valve repairs it is vital to use leaflets of appropriate size and shape, and these come from several mathematical and computational fluid dynamics studies; also various materials have been used to find the one providing the best medium and long-term results.
Conclusions and significance: The progress in the knowledge reached in the last decades, derived from extensive research studies, allowed to perform aortic valve repair with safe and sustainable results, unthinkable before.