Allograft aortic valve implantation: techniques for all types of aortic valve and root pathology

The geometry and degree of symmetry of the diseased aortic root and valve dictate the technical method of implantation of the allograft aortic valve. Five methods are available that are suitable for the full range of aortic root disease: the small aortic root with a valve annulus diameter less than 21 mm, the common aortic valve lesions (valve annulus diameter, 21 to 29 mm), the aneurysmal noncoronary sinus, the moderately large annulus (valve annulus diameter greater than 30 mm), and the aneurysmal aortic root and dilated annulus. Implantation methods include the subcoronary technique, miniroot inclusion technique, and aortic root replacement. Technical variations such as valve inversion during implantation, valve rotation, and continuous or interrupted suture methods are important in certain techniques. The allograft aortic valve is a versatile device that can be used in the surgical management of the full range of aortic valve and aortic root pathology.