Optimized use of the "skirt" of the Valsalva graft for the completion Bentall

We report the case of a patient with an aortic root aneurysm who had previously undergone aortic valve replacement with a large mechanical prosthesis which proved to be normally functioning at the time of reoperation. We describe a new technique of replacing the aortic root while retaining the existing aortic valve similar to the "completion Bentall" procedure using a 32 mm Valsalva graft by suturing the skirted portion of the graft to the sewing ring of the mechanical valve. The ability of the skirt to increase its diameter was the key of this approach.