Operative Techniques and Clinical Management
Patients were divided into three groups according to the type of valve-sparing root replacement technique utilized; Group 1 patients received a root remodeling (Yacoub) procedure, as described elsewhere. Group 2 patients underwent the reimplantation technique (David procedure).17 Group 3 patients underwent placement of a trileaflet aortic annuloplasty ring (HAART 300, Biostable), leaflet plication, and root remodeling procedure. The details of aortic annuloplasty ring sizing and placement have been previously reported.18 The root remodeling procedure was then performed using a Valsalva graft that was sized approximately 5 mm more than the size of the ring that was implanted. The left coronary button was then reimplanted, followed by the distal anastomosis of the graft to the ascending aorta. Cardioplegia was then infused to pressurize the root, the site for the right coronary button was determined, and the right coronary artery was implanted.