Aortic regurgitation is a disorder of geometry.
Understanding the mechanism
Aortic regurgitation is often a consequence of altered geometry rather than primary cusp disease. The cusps, annulus, sinuses and sinotubular junction form a functional unit. Change their dimensions or relationships and coaptation fails, even when the cusp tissue is normal.
A dilated annulus, an enlarged sinotubular junction, cusp prolapse and restricted cusp motion each need a different correction. Often more than one is present. Repair succeeds only when every relevant abnormality is recognised and addressed.
From geometry to repair
Reconstruction restores cusp configuration and coaptation. It rests on systematic assessment of root dimensions, cusp geometry and tissue quality. Effective height, geometric height and the dimensions of the functional aortic annulus give an objective basis for planning and evaluation.
The anatomy and the mechanism determine the choice between reimplantation, remodelling and isolated cusp repair. The objective is not a competent valve at the end of the operation. It is a configuration that remains stable over time.
Recognising the limits of repair
Not every valve can be reconstructed. Extensive calcification, tissue destruction, marked restriction or inadequate cusp tissue limit durable repair. Technical feasibility alone does not justify preservation.
When repair is unlikely to last, the Ross procedure, stentless valves and conventional replacement each have a place. Their suitability depends on the patient, the anatomy and the expected long-term outcome.
The question is not whether a valve can be repaired at any cost, but whether repair is the appropriate operation.
Our mission
Aortic Valve Craft promotes a systematic approach to aortic valve surgery, built on anatomy, geometric principles and critical evaluation of results. It brings together experienced surgeons and multidisciplinary specialists to examine the indications, techniques and limits of repair, reconstruction and replacement. The emphasis is on reproducibility, durability and the reasoning behind each operative decision.
Learning through decisions
Understanding a technique is different from knowing when to use it. Each masterclass combines focused lectures with interactive clinical cases. Participants see the findings, imaging and measurements, and commit to a strategy before the operation and outcome are revealed. The discussion then examines what was done, why, which alternatives existed, and whether the result supports the decision.
The inaugural masterclass, Repair. Ross. Replace., establishes this format. Future masterclasses will take each subject further.
Measure the geometry. Understand the mechanism. Then decide.
Dr Farhin Holia
Programme Director, Aortic Valve Craft
Founder and Director, Global Aorta Ltd
Physician | Clinical PhD Fellow, St Bartholomew's Hospital, Barts Health NHS Trust, QMUL | Harvard-specialised: Leadership and Management, Healthcare Leadership, Entrepreneurship and Innovation | MBA (c) Warwick
Dr Farhin Holia is a Physician with a background in Emergency Medicine and Trauma Care and a clinical researcher working at the intersection of acute care and systems reform, at The Barts Heart Centre, London. She is the Founder and Director of the Global Aorta Symposium and Chief Investigator of the Mission AORTA Research Programme.
Her academic work spans three institutions. She is a PhD Candidate at Queen Mary University of London, researching aortic syndromes through a clinical and systems lens. She holds postgraduate specialisations in Healthcare Leadership, Leadership and Management, and Entrepreneurship and Innovation from Harvard Business School. She is also an MBA Candidate at Warwick Business School, holding the Changemaker Scholarship.
Her research and advocacy work are grounded in frontline emergency medicine, built on the conviction that better systems save lives before better treatments do.
Aortic Valve Craft is an educational initiative of Global Aorta Ltd, and part of the Global Aorta Ltd group of meetings alongside the Global Aorta Symposium. It is organised by Millbrook Medical Conferences.