title: V-shape noncoronary sinus remodeling in ascending aortic aneurysm and aortic root ectasia.
abstract: The study objective was to describe our initial experience performing a V-shaped single sinus remodeling procedure in patients with ascending aortic aneurysm and moderate aortic root ectasia.
  
  
  
  Twelve consecutive patients underwent supracoronary ascending aortic replacement with V-shaped noncoronary sinus remodeling (median age, 63 years [range, 56-77]; 10 patients [83%] were male). All patients had an ascending aortic aneurysm (median diameter 48 mm [range, 42-53]) and aortic root ectasia (median root diameter, 43 mm [range, 38-49.7 mm]). A deep V-shaped (triangular) portion of the noncoronary sinus was excised, and the wall was directly reapproximated in 2 layers, 1 everting mattress suture layer followed by a running over-and-over layer.
  
  
  
  No technical complication due to root remodeling was observed. All patients survived the initial hospitalization. Only 1 patient required reexploration for bleeding, unrelated to the V-shaped repair. On postoperative computed tomography, every patient showed reduction in maximal aortic root diameter and cross-sectional area. Mean aortic root diameter was reduced from 4.30 cm (range, 3.82-4.97) to 3.81 cm (range, 3.58-3.96) (P < .0006). Mean aortic root cross-sectional area was reduced from 1452 mm2(range, 1327-1615) to 1180 mm2(range, 961-1328) (P < .0002). Mean wall tension decreased postoperatively by 12%.
  
  
  
  The V-shaped resection of the noncoronary sinus is a viable option for patients with moderate aortic root enlargement. This technique reduces aortic root diameter, cross-sectional area, and wall tension. We offer this technique as another option in the surgeon's armamentarium.
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn. Electronic address: john.elefteriades@yale.edu.
authors.forename: John A
authors.initials: JA
authors.lastname: Elefteriades
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn.
authors.forename: Sven
authors.initials: S
authors.lastname: Peterss
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn.
authors.forename: Nariman
authors.initials: N
authors.lastname: Nezami
authors.affiliation: Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn.
authors.forename: Gina
authors.initials: G
authors.lastname: Gluck
authors.affiliation: The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga.
authors.forename: Wei
authors.initials: W
authors.lastname: Sun
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn.
authors.forename: Maryann
authors.initials: M
authors.lastname: Tranquilli
authors.affiliation: Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Surgical Diseases #2, Kazan State Medical University, Kazan, Russia.
authors.forename: Bulat A
authors.initials: BA
authors.lastname: Ziganshin
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D004108:Dilatation, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: aortic aneurysm; aortic root remodeling; aortic root sparing; sinus of Valsalva