Graft Insertion Technique With Sutureless Valve Implantation in a Valsalva Graft

Objectives To describe a modification of the graft insertion technique in which a Valsalva graft-based neo-annulus is created for direct implantation of a Perceval sutureless valve in patients with complex aortic annular/root pathology. Methods We reviewed five patients who underwent graft insertion reconstruction with a Valsalva graft followed by Perceval valve implantation for complex annular/root pathology. Results A 24-mm Valsalva graft was used in all five patients; Perceval size M was implanted in four patients and size S in one. No postoperative paravalvular leakage, valve migration, or reexploration for bleeding occurred. One patient required permanent pacemaker implantation. One salvage patient with acute aortic dissection and preoperative shock died in hospital; the remaining four patients survived to discharge. Conclusions A Valsalva graft-based neo-annulus created using the graft insertion technique can provide a stable landing zone for Perceval implantation in selected patients with complex annular/root pathology. This approach represents a technical refinement of established graft insertion reconstruction and may simplify valve implantation when conventional annular fixation or direct valve seating is challenging.