David et al. devised partial remodeling, which entails replacement of any dilatated sinuses of Valsalva in addition to replacement of the ascending aorta. The procedure is performed when there is no dilatation of the aorto-ventricular junction, and the dilatation mainly affects the sino-tubular junction (STJ). Among the sinuses of Valsalva, the non-coronary sinus (NCS) and right coronary sinus (RCS) tend to enlarge readily, whereas the left coronary sinus (LCS) tends not to enlarge and can be preserved in many cases (Fig. 33.1). During the procedure, we use prosthetic vascular grafts that are cut to match the lingulate shape of the area to be replaced. This decreases the length of the suture line, which is expected to decrease both the duration of surgery and intraoperative hemorrhage . If type A acute aortic dissection (AAD) occurs, and an intimal tear extends into the sinuses of Valsalva and causes rupture, then it becomes essential to perform aortic root replacement (ARR). The Bentall procedure is usually performed, although valve-sparing aortic root replacement (VSARR) may also be considered. However, surgeons who have little experience with VSARR, which is associated with numerous challenges, may be able to shorten the duration of surgery by performing partial remodeling.
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