Fig. 2

Schematic of the AV repair and aortic root remodeling procedure. A horizontal aortotomy was made 10 mm above both coronary ostia (a). The AV cusp structures were excised fully through the aortotomy (b). A tricuspidized AV was reconstructed using the leaflet extension technique and three ready-to-use templates of bovine pericardium patches, and coaptation sutures were placed at the new commissural ends (c). Non-expandable inner and outer rings were applied at the new sinotubular junction (STJ) with penetrating sutures to reduce the dilated STJ, and a synthetic graft was subsequently wrapped around the dilated ascending aorta for further reinforcement after the aortotomy was closed (d and e)