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In many cardiac diseases it is necessary to surgically replace the ascending orta with a dacron graft and repair the aortic valve (Valve Sparing procedure).
The current surgical procedure is very complex and requires steps 1 to 6 to be performed in series. Unfortunately, only at the end of step 6 will the surgeon know whether the attempt to repair the aortic valve repair attempt performed in step 3 was successful. If not successful (at least 4.5% of cases (1)), requiring the surgeon to retrace steps 5, 4 and 3 backwards and chose an aortic valve prosthesis.
Because currently is impossible an early prediction (at step 3) of the outcome of the valve repair procedure, the surgeon often does not even attempt to repair the aortic valve, in order to avoid having to go back to surgery and increasing the surgery duration and patients’ risks, and prefers to replace it already at step 3 with a prosthesis.
The result is that less than 20% of all surgeries end in the patients’ aortic valve salvage (2).

(1) Remodeling root repair with an external aortic ring annuloplasty, Lansac et al, The Journal of Thoracic and Cardiovascular Surgery c Volume 153, Number 5
(2) Aortic valve repair—“Pearls and Pitfalls”, Youssefi et all, Journal of Visualized Surgery, 2020