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Supra-annular stitch to avoid distortion of the right coronary cusp in aortic root resuspension.

BACKGROUND AND AIM OF THE STUDY
The David procedure has been described in order to preserve the native aortic valve during correction of aortic root aneurysms, and to restore its competence in the case of aortic valve insufficiency. In general, the long-term stability of this procedure is very promising; any recurrence of aortic valve incompetence during follow up can be attributed mainly to a primary suboptimal geometry.


METHODS
A distortion of the right coronary cusp was frequently observed after using the technique as originally described. This was due to the base of the right coronary cusp (RCC) being placed deeper in the left ventricular outflow tract than the adherent septal myocardium. By placing the central stitch at the right coronary base supra-annularly, the right coronary base is not rotated outwards after tying.


RESULTS
This modification of the David procedure was carried out in 10 patients, with near-perfect valve geometry and competence.


CONCLUSION
This technical modification represents a simple and safe way to avoid distortion of the RCC in aortic root resuspension.