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.