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Ann Thorac Surg 2004;78:1479-1481
© 2004 The Society of Thoracic Surgeons

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How to do it

Simple Modification of "T. David-V" Valve-Sparing Aortic Root Replacement to Create Graft Pseudosinuses

^a Department of Thoracic and Cardiovascular Surgery, Stanford University School of Medicine, Stanford, California, USA

Accepted for publication August 21, 2003.

^* Address reprint requests to Dr Miller, Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA, USA 94305-5247
dcm{at}stanford.edu

The absence of sinuses of Valsalva is postulated to perturb coronary flow patterns and to create abnormal leaflet stresses, which theoretically may limit the long-term durability of valve-sparing aortic root replacement with the original Tirone David-I reimplantation technique with a cylindrical tube graft. David developed the "T. David-V" procedure in 2001; it creates large billowing Dacron pseudosinuses while retaining the reimplantation concept. To illustrate a simple modification of the T. David-V technique, we describe a patient with Marfan's syndrome who underwent valve-sparing aortic root replacement with 1 large and 1 small graft to create pseudosinuses in the Dacron graft, to facilitate suturing the valve inside the graft, and to make the distal graft-to-aorta anastomosis a better size match.

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