[Operation for aortic regurgitation after ascending aortic replacement].

In the clinical setting, surgery for aortic regurgitation after ascending aortic replacement is performed in a patient that underwent ascending aortic replacement due to acute aortic dissection (Stanford A). The 1st step is to determine preoperatively whether only surgery for aortic regurgitation should be performed or whether surgery should be performed for both aortic regurgitation and residual aortic dilatation. This decision should be based on the patient's general condition. Also, the possibility of preservation of the native aortic valve should be considered. Staged re-sternotomy using an inferior T-shaped mini-sternotomy is useful for a retrosternal giant aneurysm of the thoracic aorta in combined surgery on both the aortic valve and aortic aneurysm. Steady cardiac and cerebral protection is important for obtaining good results. Postoperative intensive critical care and careful follow-up in the outpatient clinic are also important. In conclusion, it is important for surgeons to become proficient in surgery for aortic valve regurgitation after ascending aortic replacement, because more of these patients will be encountered in the future.