[6] While replacement of the aortic valve is a safe and reproducible procedure it may still be associated with the long-term occurrence of so-called valve-related complications.

The goal of the procedure is the restoration of a normal form of the aortic valve, which will then lead to near-normal function and good durability of the repair.

A transesophageal echocardiogram during the operation and prior to the repair will be important to define the exact deformation of the aortic valve and thus the mechanism of regurgitation.

[citation needed] In order to best accommodate the complex geometry of the aortic valve, these procedures are generally performed through open-heart surgery.

As for aortic valve replacement, the heart-lung machine is usually connected to the patient via aorta and right atrium.

The traditional treatment of congenital aortic stenosis is balloon valvuloplasty or surgical commissurotomy.

The most reproducible concept is the creation of a bicuspid aortic valve with two normal commissures and two cusps.

[citation needed] In surgical treatment, the extent of cusp stretching is exactly determined and then corrected by sutures.

[citation needed] In bicuspid aortic valve anatomy, there is congenital fusion of two cusps.

The unicuspid aortic valve may not only result in relevant stenosis (narrowing), it may also primarily lead to regurgitation.

[12] Aortic regurgitation in a quadricuspid valve is commonly caused by the additional (4th) commissure, which holds back cusp tissue and keeps it from closing adequately.

In order to achieve this cusp, tissue is detached from the aorta and the valve is then brought into adequate form.

The enlargement of the ascending aorta may lead to aortic valve regurgitation because the outward tension on the cusps prevents their adequate closure.

For the procedure, according to Magdi Yacoub[16] a graft is tailored to create 3 tongues that replace the aneurysmatic aortic wall in the root.

[22] In most instances some cusp stretching will be found which would result in prolapse and relevant regurgitation afterward if uncorrected.

Blood-thinning may only be necessary if atrial fibrillation occurs or persists in order to prevent blood clot formation in the left atrium.

[citation needed] Following aortic valve replacement, prophylactic administration of antibiotics is recommended for interventions involving mouth and throat (e.g. dental surgery).

[23] In those times, both surgeons and cardiologists had minimal information on the exact nature and severity of dysfunction of the aortic valve.

Nonetheless, the development of heart valve prostheses made replacement the standard approach because of its reproducibility.

The first ball-cage valve was implanted in 1961 by the American surgeons Albert Starr and Lowell Edwards,[24] and in the next decades many mechanical and biological prostheses were developed and used.

The positive results with the repair of the mitral valve stimulated surgeons in the 1980s and 1990s to develop surgical techniques that could be applied for the different causes of aortic regurgitation.

Stepwise improvements were introduced in the subsequent years; today many regurgitant aortic valves can be treated by repair.