Aortic Root Replacement of Small Roots to Prepare for Transcatheter Aortic Valve Replacement.

Small aortic root is a significant limitation of optimal hemodynamics for surgical aortic valve replacement due to a small annulus and application of transcatheter aortic valve replacement due to low coronary ostia and limited space at the root. We sutured a bioprosthetic valve that was up-sized by 2 to 3 valve sizes in the skirt portion of a Valsalva graft (Terumo Medical Corp) and implanted the coronary button high, close to sinotubular junction, to achieve optimal hemodynamics and prepare patients for future transcatheter aortic valve replacement.