The Valsalva graft in aortic valve repair and replacement

Abstract

Presentation of the use of the new Valsalva graft that incorporates sinuses of Valsalva: its use is mostly recommended for the reimplantation type of valve sparing procedure where it combines the advantages of proper anatomical reconstruction with those of annular stabilization. Its advantages when used in the remodeling technique or in a classical Bentall procedure are also shown. The problem of graft sizing and of proper geometrical reconstruction of the aortic root are addressed.

Modified Repair for Huge Unruptured Aneurysm of the Right Sinus of Valsalva

“…Distortion of the sinus of Valsalva geometry can cause aortic valve regurgitation immediately or progressively after surgery. 3 Maintenance of the appropriate geometry of the sinus Valsalva after resection of the aneurysm is critical in preserving the native aortic valve and its competence, and in improving the coronary flow. 4,5 It was probably difficult in this patient with the classic method, repairing aneurysm of the sinus of Valsalva with patch completely followed by coronary button reimplantation.…”

Dacron Skirt Reconstruction of the Left Ventricular Outflow Tract: Extending the Capabilities of a Valved Conduit

“…The Valsalva graft seems to be uniquely positioned to handle the subannular reconstruction capabilities because of the skirt below the sinuses [5]. However, this capability is possible in straight Dacron tube grafts by making a ridge at a specific location of approximately 5 to 10 mm above the lower end of the graft.…”

Proposed Synthetic Tissues that Replace Human Cadavers for Training

“…The number of incidents of severe aortic stenosis in adults is remarkably high [1]. However, suitable timing of aortic valve replacement has the potential to avoid both early and late fatal events as well as result in improved functional status of the valve.…”

“…Hemodynamic assessment of the valve stenosis involves the determination of the valvular gradient and an estimation of both the aortic valve area and the aortic valve area index. If the ejection fraction and cardiac output are normal, severe aortic stenosis is detected by a pressure gradient across the valve with a value equal to or greater than 50 mmHg or by an aortic valve area index that is less than 0.75 cm 2 /m 2 [1]. If the cardiac output is lower than normal, opposed to the pressure gradient the valve area index must be considered as the pressure gradient across the valve can be minimal for decreased cardiac outflow.…”

“…If the cardiac output is lower than normal, opposed to the pressure gradient the valve area index must be considered as the pressure gradient across the valve can be minimal for decreased cardiac outflow. Aortic valve replacement is recommended even in the presence of a left ventricular ejection fraction that is less than 25% as well as for symptomatic patients with moderate aortic stenosis in which the aortic valve area is in the range of 0.7-1.2 cm 2 [1].…”