Technique
A novel composite valve graft was constructed using the Vascutek Gelweave valsalva graft with an On-X ascending aortic prosthesis (CryoLife, NW, USA). After transecting downward from the distal end of the composite graft, we marked a circular line along the edge of a sewing cuff. The circle was then cut and a ring-shaped PTFE (polyterafluoroethylene) graft was sutured at the upper margin of the sewing cuff using a continuous 4-0 polypropylene suture (Figure 1).
This hand-made composite valve graft has two sewing cuffs, which resemble the “wings of a butterfly”, that is, a lower sewing cuff (conventional sewing cuff) for annular suturing and an upper sewing cuff (the added PTFE graft) for reinforcement suturing. After conventional annular suturing, reinforcement suturing was performed between the upper sewing cuff and the residual aortic wall to reduce bleeding at the proximal anastomotic site (Figure 2).
After cardiac arrest under cardiopulmonary bypass, the aorta is completely transected and coronary buttons are excised for transposition, and then interrupted pledgeted sutures are placed on the annulus in an everting mattress fashion for annular suturing (Figure 3A). For reinforcement suturing, a continuous 4-0 polypropylene suture was used to attach the PTFE cuff to the residual aortic wall to wrap the first proximal suture line (Figure 3B).