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Updated: Dec 13, 2025

Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Valve-sparing aortic root replacement in a patient with retroaortic course of the left circumflex artery
Rody Akiel1, Julien Guihaire1,2, Marc-Antoine Isorni3
1Department of Cardiac Surgery, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis Robinson, France.
Abstract:
Anomalous origin of the left circumflex artery (LCA) arising from the right coronary sinus was observed in a 45-year-old man with aortic root aneurysm. Valve-sparing aortic root replacement (VSARR) was decided despite the subannular course of the LCA. A modified Tirone David procedure was performed with specific consideration for distribution of the proximal suture line due to the periaortic and subannular course of the LCA. Due to the risk of LCA injury, a coronary artery bypass grafting was performed using the left internal thoracic artery to secure the perfusion of the LCA. The challenging association of aortic root aneurysm and anomalous origin and course of the LCA was managed successfully during VSARR.
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