Figure 1

Surgical technique of full-root aortic xenograft implantation. The aorta is cross-clamped above the sino-tubular junction and transected at its level to inspect the aortic valve and root (a). The aortic valve is removed and the coronary ostia are dissected free from the aortic sinuses with a generous patch (b). The aortic stentless xenograft is implanted onto the surgical aortic annulus with 6 Prolene 4.0 running sutures beginning under the left coronary ostium in a clockwise manner (c). The coronary ostia are reimplanted into the stentless xenograft in a manner to avoid tension, torsion or kinking of the patient’s proximal coronary arteries (d). The implantation of the xenograft is completed by end-to-end anastomosis between the stentless xenograft and the mobilized distal aorta with a running Prolene 5.0 suture (e).