1. Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, Italy Partial aortic root remodeling with selective replacement of the non-coronary sinus: does aortic valve morphology influence outcomes? Botta L Botta L, Cannata A, Bruschi G, Trunfio S, Merlanti B, Russo CF, Taglieri C, Martinelli L.

2. Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, Italy These aneurysms begin in the ascending aorta and extend into the root and arch. The pattern of root dilation is determined by pressure and flow characteristics. The sinotubular junction (STJ) enlarges first followed by the noncoronary and right coronary sinuses. Though the annulus remains stable, the respective valve cusps are retracted and splayed producing central aortic regurgitation. The left coronary sinus usually retains normal dimensions until a very advanced stage, except in patients with sitis inversus where the left sinus dilates first.

3. Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, Italy Ascending Aorta and Isolated Non-Coronary Sinus Replacement

4. Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, Italy MATERIALS and METHODS APRIL 2003- OCTOBER 2009 29 PATIENTS Ascending Aorta and Isolated Non-Coronary Sinus Replacement Tricuspid valve: 16 Pts (13 Males, Mean Age 65 ± 11 y) Bicuspid valve: 13 Pts (11 Males, Mean Age 52 ± 12 y)

5. Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, Italy Ascending Aorta and Isolated Non-Coronary Sinus Replacement Pre-operative Features ETIOLOGY AORTIC ROOT ANEURYSM13 pts RUPTURED ANEURYSM 0 pts ACUTE TYPE A DISSECTION 0 pts PSEUDOANEURYSM0 pts 13 pts Asc Ao and NC Sinus Rep 16 pts Asc Ao and NC Sinus Rep ETIOLOGY AORTIC ROOT ANEURYSM 14 pts RUPTURED ANEURYSM 1 pt ACUTE TYPE A DISSECTION 0 pts PSEUDOANEURYSM1 pts REDO 3 pts REDO 4 pts Mean Aortic Diameter 52.7 mmMean Aortic Diameter 52.2 mm

6. Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, Italy Intra-operative Data Ascending Aorta and Isolated Non-Coronary Sinus Replacement - CPB time: 147 + 60 min - Cross Clamp Time 118 + 53 min ASSOCIATED PROCEDURES AVR7 pts LEAFLET PLASTY3 pts PROSTHETIC SUTURE0 pts - CPB time: 136 + 44 min - Cross Clamp Time 104 + 37 min 13 pts Asc Ao and NC Sinus Rep 16 pts Asc Ao and NC Sinus Rep ASSOCIATED PROCEDURES AVR5 pts LEAFLET PLASTY2 pts PROSTHETIC SUTURE2 pts

7. Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, Italy IN-HOSPITAL OUTCOMES Ascending Aorta and Isolated Non-Coronary Sinus Replacement Post-Operative stay: 7 Days (median) 30 days MORTALITY: 0 pts 30 days MORBIDITY 30 days MORBIDITY - Stroke 1pt - Renal/Respiratory Failure 1pt 30 days MORBIDITY 30 days MORBIDITY - Ventricular Fibrillation 1 pt - Peripheral embolism 1 pt

8. Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, Italy FOLLOW-UP LATE MORTALITY: 0 pts Mean: 27.3 months Ascending Aorta and Isolated Non-Coronary Sinus Replacement LATE MORBIDITY: 0 pts AORTIC DISSECTION: 0 pts RE-OPERATIONS: 0 pts Mean: 32.3 months 100% completed

9. Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, Italy When dilatation of the aortic root is confined to the Non-coronary sinus of Valsalva, the selective replacement of this sinus may represent a good compromise, with excellent early and midterm outcomes. In patients with a bicuspid aortic valve, risk of aortic related adverse events is rare and similar to that of patients with a tricuspid valve. CONCLUSIONS More patients and a longer follow-up is mandatory to confirm these preliminary results.

10. Luca Botta MD, Cardiac Surgery Unit Niguarda Cà Granda Hospital, Milan, Italy THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION