title: The ideal theoretical graft oversizing in valve-sparing aortic operations with a standard tubular or a Valsalva graft.
abstract: OBJECTIVE
  We sought to determine, by a mathematical model, the ideal theoretical degree of ascending aortic graft oversizing needed to obtain normal sinuses dimension in the reimplantation type of valve-sparing aortic operations.
  
  
  METHODS
  To define a normal-range value, size of sinuses of Valsalva was conventionally expressed as the area surrounding fully opened aortic cusps, the so-called beyond leaflets area (BLA), and measured in 50 healthy subjects. A mathematical relationship between aortic annulus diameter, aortic sinuses diameter and resulting BLA was defined. By simulating intra-operative scenarios, the effect of different degrees of a standard or Valsalva graft oversizing on BLA extension was tested.
  
  
  RESULTS
  The same degree of graft oversizing resulted in a bigger beyond leaflets area for the Valsalva graft than for a standard graft. Oversizing degrees exceeding +7mm for a standard graft and +3mm for the Valsalva graft resulted in a beyond leaflets area over normal limits. Results were expressed in a visual form as two different normograms, one for the standard graft and one for the Valsalva graft.
  
  
  CONCLUSIONS
  A less pronounced graft oversizing is needed to achieve normal-range sinuses size when using a Valsalva graft, the ideal theoretical graft oversizing was +7mm for a standard graft and +3mm for the Valsalva graft, our normograms can be helpful in selecting a proper graft size when performing a valve-sparing aortic procedure.
authors.affiliation: Department of Cardiothoracic Surgery, Azienda Ospedaliera Pisana, 56124 Pisa, Italy. dmaselli@tiscali.it
authors.forename: Daniele
authors.initials: D
authors.lastname: Maselli
authors.forename: Gabriele
authors.initials: G
authors.lastname: Borelli
authors.forename: Andrea
authors.initials: A
authors.lastname: Amerini
authors.forename: Pietro
authors.initials: P
authors.lastname: Bajona
authors.forename: Luca
authors.initials: L
authors.lastname: Bellieni
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Croccia
authors.forename: Gaetano
authors.initials: G
authors.lastname: Minzioni
mesh_terms: D000328:Adult; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011474:Prosthesis Design; D012016:Reference Values; D012092:Replantation / Q000379:methods; D012850:Sinus of Valsalva / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000601:surgery*; D014463:Ultrasonography