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Eur J Cardiothorac Surg 2005;28:845-849
© 2005 Elsevier Science NL

The ideal theoretical graft oversizing in valve-sparing aortic operations with a standard tubular or a Valsalva graft

^a Department of Cardiothoracic Surgery, Azienda Ospedaliera Pisana, 56124 Pisa, Italy
^b Department of Cardiology, Azienda Ospedaliera Pisana, 56124 Pisa, Italy

Received 11 August 2005; received in revised form 21 September 2005; accepted 22 September 2005.

^_* Corresponding author. Tel.: +39 050 995261; fax: +39 050 995271. (Email: dmaselli{at}tiscali.it).

Objective: We sought to determine, by a mathematical model, the ideal theoretical degree of ascending aortic graft oversizing needed to obtain normal sinuses dimension in the reimplantation type of valve-sparing aortic operations. Methods: To define a normal-range value, size of sinuses of Valsalva was conventionally expressed as the area surrounding fully opened aortic cusps, the so-called beyond leaflets area (BLA), and measured in 50 healthy subjects. A mathematical relationship between aortic annulus diameter, aortic sinuses diameter and resulting BLA was defined. By simulating intra-operative scenarios, the effect of different degrees of a standard or Valsalva graft oversizing on BLA extension was tested. Results: The same degree of graft oversizing resulted in a bigger beyond leaflets area for the Valsalva graft than for a standard graft. Oversizing degrees exceeding +7 mm for a standard graft and +3 mm for the Valsalva graft resulted in a beyond leaflets area over normal limits. Results were expressed in a visual form as two different normograms, one for the standard graft and one for the Valsalva graft. Conclusions: A less pronounced graft oversizing is needed to achieve normal-range sinuses size when using a Valsalva graft, the ideal theoretical graft oversizing was +7 mm for a standard graft and +3 mm for the Valsalva graft, our normograms can be helpful in selecting a proper graft size when performing a valve-sparing aortic procedure.

Key Words: Aortic valve-sparing operation • Sinuses of Valsalva • Aortic valve reimplantation • Aortic root sizing