Composite root replacement at the level of the aortoventricular junction.

Abstract

Composite root replacement has become the gold standard treatment for many root pathologies. The results are excellent; however, postoperative heart block does occur. We have adopted a modification of the conventional suture placement techniques aiming to reduce this complication. By skeletonizing the root and passing the valve sutures transmurally at the level of the anatomic aortoventricular junction rather than through the surgical annulus we give wide berth to the conduction system. This also facilitates placement of a hemostatic running suture around the prosthesis, if desired. We have seen a reduction in heart block requiring pacemaker implantation without prolongation of bypass or cross-clamp times.