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Updated: May 29, 2026

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Composite root replacement at the level of the aortoventricular junction
Daniel Pereda1, Thoralf M Sundt
1Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Composite root replacement is a standard treatment, but can cause heart block. A modified suture technique, passing sutures transmurally at the aortoventricular junction, reduces heart block requiring pacemakers without increasing surgery time.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
Background:
- Composite root replacement is a widely adopted gold standard for treating root pathologies.
- Postoperative heart block is a known complication, necessitating pacemaker implantation in some cases.
Purpose of the Study:
- To present a modified suture placement technique for composite root replacement.
- To reduce the incidence of postoperative heart block requiring pacemaker implantation.
Main Methods:
- Skeletonizing the root during composite root replacement.
- Passing valve sutures transmurally at the anatomic aortoventricular junction, avoiding the surgical annulus.
- Facilitating placement of a hemostatic running suture around the prosthesis.
Main Results:
- Observed a reduction in heart block requiring pacemaker implantation.
- No prolongation of cardiopulmonary bypass or cross-clamp times was noted.
Conclusions:
- The modified suture technique effectively minimizes heart block complications after composite root replacement.
- This technique offers a safer approach to composite root replacement by protecting the cardiac conduction system.
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13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
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