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Updated: Feb 10, 2026

Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Left-right commissural aortic root enlargement facilitates valve-in-valve transcatheter aortic valve implantation: A
Jahangir H Charania1, Logan Atkinson2, Sorush Rokui2
1Division of Cardiology, Royal Columbian Hospital, New Westminster, British Columbia, Canada.
Objective:
Aortic root enlargement (ARE) at the left-right (LR) commissure may mitigate risk of coronary obstruction during future valve-in-valve (VinV) transcatheter aortic valve implantation (TAVI) by creating space for blood flow behind the LR surgical valve strut into the adjacent sinuses. We analyzed computed tomography (CT) scans after LR ARE to determine theoretical candidacy for future VinV TAVI.
Methods:
All patients undergoing LR ARE and bioprosthetic surgical aortic valve replacement (SAVR) between February 2023 and November 2024 were reviewed retrospectively. Postoperative CT scans were analyzed, modeling for both balloon-expandable (BEV) and self-expanding (SEV) valves. Risk of coronary obstruction was based on virtual transcatheter valve to coronary (VTC) and sinotubular junction (VTSTJ) distances, and measurements of the LR ARE patch.
Results:
There were 32 patients (62% female, 44% inpatient) who had LR ARE with bioprosthetic SAVR, including 22% with a concomitant Y ARE. There was no 30-day mortality or stroke. Postoperative mean gradient was 5.5 mm Hg. Overall, 85% of valves were 23 or 25 mm, representing upsizing by 1.7 ± 0.7 sizes. The patch was 26.2 ± 4.7 mm tall, with 6.2 ± 2.4 mm of space behind the LR strut. If a SEV were used, 94% would be safe for VinV TAVI with low risk of coronary obstruction; if balloon inflation were needed during TAVI (such as for BEV), 77% could have safe VinV TAVI.
Conclusions:
In this CT analysis, LR ARE carried low risk of coronary obstruction for future VinV TAVI and may benefit patients undergoing bioprosthetic SAVR.
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