How to avoid crimping during valve sparing aortic root replacement using the Valsalva graft

The reimplantation technique for valve sparing aortic root replacement (David I) has improved management of patients with aortic root aneurysm and structurally normal aortic valves. The Valsalva graft (Gelweave Valsalva, Sultzer Vascutek, Renfrewshire, Scotland) further simplified the procedure by offering a root prosthesis with preformed neo-sinuses that may reduce physiologic stresses on valve leaflets and improve long-term valve durability. However, in-conduit suturing of the aortic valve annulus and a small rim of sinus remnant to the graft sinuses may create folds of the sinus remnant that lead to bleeding or distortion of the prosthetic root. We report a method to minimize crimping of the aortic graft sinuses.