“…The inner diameter of the bioprosthetic valve is 5 to 7 mm smaller than the labeled size (defined by a historical American Society for Artificial Internal Organs conference for a stented bioprosthesis as the distance between 2 parallel lines located at the outside border of the struts) after implantation because of the sewing ring, strut material, and aortic annular tissue protruding inside the sewing ring of the valve ( Figure 2 , A ). 2 After SAVR, the inner diameter of the prosthetic valve becomes the new “basal ring” of the prosthetic valve, which can be 5 to 7 mm smaller than the patient's native basal ring 2 ( Figure 2 , A ). This is why it is necessary to upsize the prosthetic valve by 3 to 4 valve sizes to have an inner diameter matching the patient's native basal ring, especially in active patients 2 ( Figure 2 , B and C ).…”
mentioning
confidence: 99%
“… 2 After SAVR, the inner diameter of the prosthetic valve becomes the new “basal ring” of the prosthetic valve, which can be 5 to 7 mm smaller than the patient's native basal ring 2 ( Figure 2 , A ). This is why it is necessary to upsize the prosthetic valve by 3 to 4 valve sizes to have an inner diameter matching the patient's native basal ring, especially in active patients 2 ( Figure 2 , B and C ). Figure 2 Three cases of aortic valve replacement in 3 patients, all of whom had a 23-mm basal ring.…”
mentioning
confidence: 99%
“…Our AAE technique enlarges the anatomic aortic annulus and root with a Y-incision without incising into the basal ring or LVOT. This allows us to place prosthetic valves upsized by 3 to 4 sizes above (supra-annular) 2 or inside the residual anatomic annulus (intra-annular) and the patch (such as intra-annular implantation of St Jude mechanical valve). 4 The upsized valve has an inner diameter close to the diameter of patient's native basal ring.…”
mentioning
confidence: 99%
“…Despite the large-size valve implanted, the postoperative mean gradient across the aortic valve (7 mm Hg) is still greater than that across the LVOT (2 mm Hg), which remains the same as the preoperative LVOT gradient. 2 The normal basal ring and LVOT do not need to be enlarged, since we do not place a prosthetic valve in the basal ring or LVOT. The same concept applies when a total root replacement is used in an extra-anatomic fashion to implant a larger valve for a small aortic annulus/root.…”
mentioning
confidence: 99%
“…However, we predominately upsize by 3 to 4 valve sizes. 2 The “roof” technique is to resolve the kink between the enlarged root and native ascending aorta. Fifty percent of patients in our early series had no “roof” technique but with no hemodynamical significance.…”
“…The inner diameter of the bioprosthetic valve is 5 to 7 mm smaller than the labeled size (defined by a historical American Society for Artificial Internal Organs conference for a stented bioprosthesis as the distance between 2 parallel lines located at the outside border of the struts) after implantation because of the sewing ring, strut material, and aortic annular tissue protruding inside the sewing ring of the valve ( Figure 2 , A ). 2 After SAVR, the inner diameter of the prosthetic valve becomes the new “basal ring” of the prosthetic valve, which can be 5 to 7 mm smaller than the patient's native basal ring 2 ( Figure 2 , A ). This is why it is necessary to upsize the prosthetic valve by 3 to 4 valve sizes to have an inner diameter matching the patient's native basal ring, especially in active patients 2 ( Figure 2 , B and C ).…”
mentioning
confidence: 99%
“… 2 After SAVR, the inner diameter of the prosthetic valve becomes the new “basal ring” of the prosthetic valve, which can be 5 to 7 mm smaller than the patient's native basal ring 2 ( Figure 2 , A ). This is why it is necessary to upsize the prosthetic valve by 3 to 4 valve sizes to have an inner diameter matching the patient's native basal ring, especially in active patients 2 ( Figure 2 , B and C ). Figure 2 Three cases of aortic valve replacement in 3 patients, all of whom had a 23-mm basal ring.…”
mentioning
confidence: 99%
“…Our AAE technique enlarges the anatomic aortic annulus and root with a Y-incision without incising into the basal ring or LVOT. This allows us to place prosthetic valves upsized by 3 to 4 sizes above (supra-annular) 2 or inside the residual anatomic annulus (intra-annular) and the patch (such as intra-annular implantation of St Jude mechanical valve). 4 The upsized valve has an inner diameter close to the diameter of patient's native basal ring.…”
mentioning
confidence: 99%
“…Despite the large-size valve implanted, the postoperative mean gradient across the aortic valve (7 mm Hg) is still greater than that across the LVOT (2 mm Hg), which remains the same as the preoperative LVOT gradient. 2 The normal basal ring and LVOT do not need to be enlarged, since we do not place a prosthetic valve in the basal ring or LVOT. The same concept applies when a total root replacement is used in an extra-anatomic fashion to implant a larger valve for a small aortic annulus/root.…”
mentioning
confidence: 99%
“…However, we predominately upsize by 3 to 4 valve sizes. 2 The “roof” technique is to resolve the kink between the enlarged root and native ascending aorta. Fifty percent of patients in our early series had no “roof” technique but with no hemodynamical significance.…”
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