1. Implantation technique of aortic homograft root: emphasis on matching the host root to the graft 
William F Northrup, MD, Vibhu R Kshettry, MD 
The Annals of Thoracic Surgery 
Volume 66, Issue 1, Pages (July 1998)
DOI: /S (98)

2. Fig 1
Anatomic landmarks of left ventricular outflow tract and aortic root. (a) Surgeon’s view of the aortic root from the right side. (b) Opened aortic root. (c) Approximately 55% of the left ventricular outflow tract is fibrous and 45% is muscular.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

3. Fig 2
Measurement of coronary distance above the horizontal plane of annulus and intercoronary distance across left/right commissure. These measurements are taken as a guide for selecting the proper site of the host coronary ostia implantation in the homograft. The surgeon should not be committed to using the homograft coronary ostia if they are not in location corresponding to those of the host.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

4. Fig 3
Priority zone 1 (non/left interleaflet triangle): reduction annuloplasty with figure-of-8 suture. Ten- to 15-mm plication can be achieved without distorting adjacent structures.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

5. Fig 4
Priority zone 2 (left/right interleaflet triangle): reduction annuloplasty using mattress compression suture.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

6. Fig 5
Priority zone 3 (right/non-interleaflet triangle): deep sutures are avoided because of risk of injury to conduction tissue. This site for reduction annuloplasty is rarely used. Also shown are priority zone 4 (aortic–mitral curtain) and priority zone 5 (muscular septum and free wall).
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

7. Fig 6
Correction of minor mismatch between host graft annulus by taking wider (2- 3-mm) intervals in the host annulus. This results in circumferential plication of the annulus when sutures are tied. (a = 1- 2-mm suture interval in the graft annulus; b = 2- 3-mm suture interval in recipient annulus; c = circumferential plication of recipient annulus.)
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

8. Fig 7
One end of the pericardial strip is anchored by passing a suture through it. The pericardial strip is passed within each suture loop evenly distributed, and the sutures are securely tied and cut. This buttressing strip of pericardium aids in hemostasis and prevents any late dilatation of the annulus.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )

9. Fig 8
Coronary button anastomosis. The suture line is placed around the edge of coronary ostia, incorporating surrounding aortic tissue. The host aortic sinus wall outside the suture line with its broad surface of coaptation against the graft serves as its own buttress to facilitate hemostasis—an endobutton buttress. The distal suture line is reinforced with a pericardial strip.
The Annals of Thoracic Surgery  , DOI: ( /S (98) )