Valsalva-shaped bio-root: an alternative technique for aortic root replacement using a stented bioprosthesis

Introduction: Valsalva sinuses are thought to enhance native or prostethic leaflets longevity, and restore the prompting effect on the coronary flow. The commercial Valsalva prostheses pose problems of their technical flexibility, availability, and cost. Herein, we report on a new method to perform a homemade Valsalva bio-root (VSBR) that offers technical flexibility and potential to be implanted wide-spread.

Methods: Since august 2009, two male patients underwent emergent aortic root replacement on the basis of impending rupture of aortic root aneurysms using the current technique consistsing on performing a VSBR, incorporating a stented bioprosthesis, to be implanted as exclusion/button technique.

Results: The mean age was 40 y.o, the mean preoperative LVEF of 22%, and the mean diameter of aortic root aneurysm was 11cm. The mean diameter of aorto-ventricular junction was 27mm and one patient needed concomitant aortic annuloplasty. The mean diameter of the neosinuses and ascending aorta prostheses were 30 and 26mm respectively. Two Epic bioprosthesis (25 and 27mm) were used. The postoperative echocardiography and CT-angiography displayed normal bioprosthesis function and effective creation of neosinuses.

Conclusion: Creating neosinuses may enhance the longevity of stented bioprosthesis. VSBC offers technical advantages such as better control for coronary reipmlantation from inside the graft, flexibility in terms of choosing the type of bioprosthesis, the appropriate height, and the diameter of Valsalva neo-sinuses compared to commercial Valsalva-grafts. By aborting secondary degenerative classification of Valsalva sinuses, it can be an attractive alternative to aortic root replacement by stentless bioprosthesis in view of further reoperation.