A simplified approach to determine the ventriculoaortic junction diameter in the reimplantation procedures.

Abstract

In aortic valve–sparing procedures, sufficient effective height (EH) is essential for long-term aortic valve durability.1 The plication of the nodule of Arantius (central plication) and the free margin resuspension with polytetrafluoroethylene sutures are performed to obtain sufficient EH, but overcorrection brings the immobility of the cusp and the gap in the central coaptation zone. In the reimplantation procedure, reducing the ventriculoaortic junction (VAJ) diameter with the proximal suture line is another option for increasing the coaptation height2; however, the degree of the reduction must be decided at the beginning of the procedure before the cusp configuration is completed.