LGS modified aortic valve reimplantation with neosinus creation for aortic root aneurysm

Valve-sparing aortic root replacement is an alternative to composite valve conduit replacement in patients with a morphologically preserved aortic valve and aortic root aneurysm or dilation. This video tutorial demonstrates a modified aortic valve reimplantation technique in which the aortic anulus is sized to the expected normal diameter for the patient's sex and body surface area, using a Hegar dilator as a sizing guide. The aortic valve is mobilized, and pledgeted sutures are passed from inside the left ventricular outflow tract through a straight polyester tube graft, then tied down around the appropriately sized Hegar dilator. This step reduces the annulus to a normal calibre and simultaneously creates neosinuses above the left ventricular outflow tract to accommodate cusp motion. The valve is sewn into the graft, commissures are resuspended as needed, and the neosinotubular junction is recreated by spacing the commissural sutures 4-5 mm apart. The coronary buttons are reimplanted, and the repair is completed with cardioplegia testing for valve competence. This technique has been used in over 500 patients with excellent mid- and long-term freedom from reintervention and low rates of residual aortic regurgitation.