Sizing for modified david’s reimplantation procedure

The problem of sizing the graft, annulus, and left ventricular outflow tract for the David reimplantation type of aortic valve preserving procedure remains a concern, particularly in patients with Marfan syndrome. To resolve this issue, a modified method used in over 20 patients is described of doing the repair around a Hegar’s dilator. In essence, the size chosen is according to the patient’s normalized annular size based on body surface area. This technique also creates a neosinus in the root.