Abstract
Accurate positioning of a prosthetic aortic valve, in the native aortic annulus, is essential to prevent paravalvular leak. However, it may be difficult to achieve good apposition between a rigid prosthetic valve and deeply scalloped annulus. Ubiquitous to cardiac operating sets, a soft plastic snugger can be used to secure the middle suture in each sinus. This flattens and approximates the annulus while sutures are tied from each commissure towards the snugger, ensuring a good seal (Fig 1). Finally, the snugger is removed and the last suture tied. This is a safe, affordable and reproducible method of accurately seating a prosthetic valve. Figure 1 Soft plastic snugger to secure sutures in non-coronary cusp while tying valve into place
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