Aortic valve-sparing root replacement from inside the aorta using three Dacron skirts preserving the native Valsalva sinuses geometry and stabilizing the annulus

We present an alternative idea for valve-sparing technique combining the advantages of the reimplantation and the benefits of the remodeling techniques. We replace the sinuses of Valsalva using three Dacron skirts from inside of the aorta. The physiological anatomy of the Valsalva sinuses and their dynamic properties are preserved and the aortic commissures displacement avoided. The distal rim of each Dacron skirt was anchored to the aorto-ventricular junction using Ticron (2-0) U stitches placed from the ventricular side to the aortic side. We stabilize the base of the aortic annulus to prevent future dilation.