Early and Medium Term Results of the Sleeve Valve-Sparing Procedure for Aortic Root Ectasia Amando Gamba, MD, Giordano Tasca, MD, Floriana Giannico,

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Early and Medium Term Results of the Sleeve Valve-Sparing Procedure for Aortic Root Ectasia Amando Gamba, MD, Giordano Tasca, MD, Floriana Giannico, MD, Elisabetta Lobiati, MD, Douglas Skouse, MD, Andrea Galanti, MD, Antonello Stefano Martino, MD, Michele Triggiani, MD The Annals of Thoracic Surgery Volume 99, Issue 4, Pages 1228-1233 (April 2015) DOI: 10.1016/j.athoracsur.2014.10.044 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Graft preparation by trimming the proximal collar into 3 small crescent shapes and making 2 keyholes partially surrounded by small radial incisions. The Annals of Thoracic Surgery 2015 99, 1228-1233DOI: (10.1016/j.athoracsur.2014.10.044) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The graft is secured by a stitch at each nadir of the aortic cusp (lower suture). Another stitch is placed at the level of the vertical slit of each keyhole, underneath each coronary artery (upper suture). The Annals of Thoracic Surgery 2015 99, 1228-1233DOI: (10.1016/j.athoracsur.2014.10.044) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The aortic STJ is secured to the STJ of the graft by a running suture. At least 1 cm or more of straight graft is left according to the amount of ascending aorta that needs to be replaced. (STJ = sinotubular junction.) The Annals of Thoracic Surgery 2015 99, 1228-1233DOI: (10.1016/j.athoracsur.2014.10.044) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Changes in aortic regurgitation (AR) degree from the preoperative phase (black bar) to discharge (gray bar) and follow-up (white bar). The Annals of Thoracic Surgery 2015 99, 1228-1233DOI: (10.1016/j.athoracsur.2014.10.044) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Computed tomographic scan 1 year postoperatively. Note the normal shape of the aortic root. The Annals of Thoracic Surgery 2015 99, 1228-1233DOI: (10.1016/j.athoracsur.2014.10.044) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions