Valve-sparing root replacement—reimplantation technique

Abstract

The first valve sparing root replacement (VSRR) was first described over thirty years ago. Reimplantation is favored at our institution to provide maximum annular support in the setting of annuloaortic ectasia. Multiple iterations for this operation have been reported. Surgical intervention varies in terms of graft sizing, the number and method of inflow suture placement, strategy for annular plication and stabilization, and finally choice of graft type. Our specific technique has evolved over the last eighteen years and the current approach is to use a larger straight graft loosely based on the original Feindel-David formula, six inflow sutures to anchor the graft, and some degree of annular plication with annular stabilization. The long-term results for both trileaflet and bicuspid valves are associated with a low reintervention rate. Herein we provide a clear outline for our specific approach to the reimplantation technique.

Half back stitch for root reimplantation

“…This is technically hard, but of paramount importance to avoid the architectural distortion that may result in serious bleeding and architectural distortion of the root geometry. 2 On the contrary, the half back stitch involves straightforward penetration of each stitch because the suture line only exists in the overlapping area of the native aortic rim and the graft. In addition, the half back stitch may offer more stable hemostasis because it makes reinforced layers of suture lines.…”

“…The standard manner thereafter is to make hemostatic layer stitches to reattach the native aortic valve (AV) annulus inside the tubular graft using continuous over-and-over sutures referred to as the whip stitch technique in classic root reimplantation ( Figure E1 ). 2 We, however, have adopted a modified version of these attachment sutures; namely, the half back stitch ( Figure 1 ). The aorta wall resection (remaining 3 mm) in the half back stitch technique is not different from standard root reimplantation using the whip stitch technique.…”