Key result
Modified aortic valve reimplantation with neosinus creation yields durable long-term freedom from reintervention and AR.
Why the study?
Valve-sparing aortic root replacement is an alternative to composite valve conduit replacement in patients with a morphologically preserved aortic valve and aortic root aneurysm or dilation. This tutorial demonstrates a modified aortic valve reimplantation technique with neosinus creation.
This video tutorial demonstrates a modified valve-sparing aortic root replacement technique with neosinus creation that has shown excellent mid- and long-term freedom from reintervention and low rates of residual aortic regurgitation in over 500 patients.
Modified annular sizing in valve-sparing reimplantation may guide technique; leaves open comparative outcome data.
Valve-sparing aortic root replacement is an alternative to composite valve conduit replacement in patients with a morphologically preserved aortic valve and aortic root aneurysm or dilation. This video tutorial demonstrates a modified aortic valve reimplantation technique in which the aortic anulus is sized to the expected normal diameter for the patient's sex and body surface area, using a Hegar dilator as a sizing guide. The aortic valve is mobilized, and pledgeted sutures are passed from inside the left ventricular outflow tract through a straight polyester tube graft, then tied down around the appropriately sized Hegar dilator. This step reduces the annulus to a normal calibre and simultaneously creates neosinuses above the left ventricular outflow tract to accommodate cusp motion. The valve is sewn into the graft, commissures are resuspended as needed, and the neosinotubular junction is recreated by spacing the commissural sutures 4-5 mm apart. The coronary buttons are reimplanted, and the repair is completed with cardioplegia testing for valve competence. This technique has been used in over 500 patients with excellent mid- and long-term freedom from reintervention and low rates of residual aortic regurgitation.
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Mitar et al. (2026) studied Aortic root aneurysm or dilation with morphologically preserved aortic valve (n=500). Modified aortic valve reimplantation with neosinus creation was evaluated on Freedom from reintervention and residual aortic regurgitation. Modified aortic valve reimplantation with neosinus creation achieved excellent mid- and long-term freedom from reintervention and low residual aortic regurgitation in >500 patients.
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