D.Craig Miller, MD The Journal of Thoracic and Cardiovascular Surgery

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Valve-sparing aortic root replacement in patients with the Marfan syndrome D.Craig Miller, MD The Journal of Thoracic and Cardiovascular Surgery Volume 125, Issue 4, Pages 773-778 (April 2003) DOI: 10.1067/mtc.2003.162 Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 A, Operative photograph of “T. David-V” reimplantation valve-sparing aortic root replacement in a patient with the MFS illustrating how the over-sized 32-mm woven double velour Hemashield graft (Medi-Tech, Boston Scientific Corp, Natick, Mass) is necked down proximally to fit a 25-mm valve sizer using interrupted 5-0 plication sutures (red arrows). B, The valve is sewn inside the graft before the distal end of the graft is plicated. Using a larger graft facilitates exposure and eliminates buckling and crowding of the aortic root tissue when sewing the scalloped upper valve suture line compared with when a smaller, cylindrical tube graft is used, as in the “T. David-I” procedure. C, Completed operation showing the reimplanted right coronary artery button and interrupted 5-0 braided polyester plication sutures (some of which are denoted by the white arrows) at the top of the commissures to neck down the sinotubular junction of the graft. The Journal of Thoracic and Cardiovascular Surgery 2003 125, 773-778DOI: (10.1067/mtc.2003.162) Copyright © 2003 American Association for Thoracic Surgery Terms and Conditions