• Daniele Maselli, Gabriele Borelli, Andrea Amerini, Pietro Bajona, Luca Bellieni, Mariagrazia Croccia, and Gaetano Minzioni.
• Department of Cardiothoracic Surgery, Azienda Ospedaliera Pisana, 56124 Pisa, Italy. dmaselli@tiscali.it
• Eur J Cardiothorac Surg. 2005 Dec 1; 28 (6): 845-9.

ObjectiveWe 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.MethodsTo 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.ResultsThe 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.ConclusionsA 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.

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