Repair of Aortic Valve Insufficiency and Ascending Aortic Aneurysm Using Geometric Ring Annuloplasty.

This video demonstrates aortic valve repair during ascending aneurysm replacement for a 71-year-old man with congestive heart failure, grade 3 aortic insufficiency, and a 5.4-cm ascending aneurysm. On testing, the noncoronary leaflet is prolapsing, the annulus is 27 mm, and the leaflets size to a 21-mm ring. The ring is sutured beneath the aortic valve annulus with nine horizontal mattress sutures. The noncoronary leaflet is plicated, correcting the prolapse. A 28-mm Dacron tube graft (Maquet Hemashield, Baden-Württemberg, Germany) is sutured to the supracoronary and distal aorta. After repair, aortic insufficiency is trivial with a mean systolic gradient of 9 mm Hg. The patient recovered uneventfully.