An aortic ring: From physiologic reconstruction of the root to a standardized approach for aortic valve repair Emmanuel Lansac, MD, PhD, Isabelle Di.

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An aortic ring: From physiologic reconstruction of the root to a standardized approach for aortic valve repair Emmanuel Lansac, MD, PhD, Isabelle Di Centa, MD, Ghassan Sleilaty, MD, Eric Arnaud Crozat, MD, Olivier Bouchot, MD, PhD, Rachid Hacini, MD, Dominique Blin, MD, Fabien Doguet, MD, PhD, Jen-Paul Bessou, MD, PhD, Bernard Albat, MD, PhD, Roland De Maria, MD, PhD, Jean-Pierre Villemot, MD, PhD, Eric Portocarrero, MD, Christophe Acar, MD, PhD, Didier Chatel, MD, Stéphane Lopez, MD, Thierry Folliguet, MD, PhD, Mathieu Debauchez, MD The Journal of Thoracic and Cardiovascular Surgery Volume 140, Issue 6, Pages S28-S35 (December 2010) DOI: 10.1016/j.jtcvs.2010.08.004 Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Standardized steps in remodeling of aortic root associated with an external subvalvular aortic ring annuloplasty. A, Five U stitches are circumferentially placed, inside out, in the subvalvular plane (∗bundle of His). B, The ring is pulled around the graft and tied in the subvalvular position. C, Final aspect after coronary ostia reimplantation. D, Criteria for selection of the prosthetic annuloplasty ring size (Extra-Aortic, Coroneo, Inc,)and tube graft size (Gelweave Valsalva). NC, noncoronary; RC, right coronary; LC, left coronary. The Journal of Thoracic and Cardiovascular Surgery 2010 140, S28-S35DOI: (10.1016/j.jtcvs.2010.08.004) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Standardized steps for cusp repair. A and B, Alignment of adjacent cusp free edges evaluates the excess length, which is corrected by plicating central stitches. C, Cusp effective height is measured using a dedicated cusp caliper (Fehling Instruments) after root remodeling and previous ring implantation. Residual or induced cusp prolapse was corrected by additional central plicating stitches. The Journal of Thoracic and Cardiovascular Surgery 2010 140, S28-S35DOI: (10.1016/j.jtcvs.2010.08.004) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A, Freedom from AI grade 2 or greater in 3 groups (P = .03). B, Freedom from composite outcome in 3 groups (P = .02). C, Freedom from AI grade 2 or greater between bicuspid and tricuspid aortic valves (P = .17). D, Freedom from composite outcome for bicuspid and tricuspid valves (P = .06). The Journal of Thoracic and Cardiovascular Surgery 2010 140, S28-S35DOI: (10.1016/j.jtcvs.2010.08.004) Copyright © 2010 The American Association for Thoracic Surgery Terms and Conditions