Implantation of a larger aortic prosthetic valve in a patient with a small aortic annulus: an operative technique.

A technique for implantation of a larger aortic prosthetic valve in a small aortic annulus is described. The technique consists of passing inverted horizontal mattress sutures in the aortic annulus in the right and left coronary sinuses. In the noncoronary sinus, horizontal mattress sutures are passed from outside through a strip of Teflon felt and then through the aortic wall a few millimeters away from the annulus and finally through the sewing ring of the aortic valve prosthesis. Sutured in this manner, the valve sits below the annulus in the areas of the right and the left coronary sinuses and above the annulus in the noncoronary sinus. This technique is simple, does not add to the aortic cross-clamp time, and permits placement of a prosthesis that is at least 2-4 mm larger than the size of the annulus.