Valsalva graft in the Bentall procedure: from mechanical valve to the BioValsalva, world's first biological aortic conduit

Aortic root replacement is the procedure of choice for patients with ascending aortic aneurysms and diseased aortic valve leaflets. The increasing age of patients who undergo aortic root surgery, and data that support the use of a biological aortic valve in the younger population, have significantly increased the need for a composite biological valved conduit. The third-generation Triplextrade (Terumo Vascutek, Renfrewshire, Scotland, UK) Dacron conduit with its three-layer technology, can be stored in glutaraldehyde along with biological prostheses while maintaining a complete blood impermeability. As the result of this fundamental improvement, the ready-to-use composite biological valved graft is currently available for the first time in different sizes, which avoids the need of assembling it on the surgical table. The procedure is expedited and a better hemostasis achieved because of the intrinsic characteristics of the new three-layered conduit. The BioValsalva (Terumo Vascutek, Renfrewshire, Scotland, UK) has been obtained by suturing a stentless aortic valve (Elan, Kohler, Leeds, UK) inside a Triplex Valsalva graft and combining the advantages of a biological valved conduit with the advantages of better leaflets dynamics, less tension on coronary ostia, and improved coronary flow proper of the Valsalva conduit. The authors' preliminary clinical experience with the BioValsalva is reported herein and the technique is discussed.