Re-creation of a sinuslike graft expansion in Bentall procedure reduces stress at the coronary button anastomoses: A finite element study

The Valsalva graft consists of a standard Dacron tube attached to a lower section (skirt) of a Dacron tube that expands circumferentially. The collar offers a tubular portion for proper suturing of the valve prosthesis and the patient's annulus (courtesy of Vascutek Terumo, Renfrewshire, UK).

Von Mises charts of computer-aided design generated 3-dimensional meshed models of aortic root–coronary artery assemblies, showing changes in stress pattern when the model configuration was progressively changed from a standard straight conduit (top, left) to conduits with a progressively increased sinus portion (bottom, right). Pressure was maintained constant at 200 mm Hg.

Von Mises charts of computed tomographic scan–derived actual aortic root–coronary artery assemblies, showing stress pattern in normal individuals (left) and in patients having a Bentall procedure with a standards straight conduit (center) or a Valsalva conduit (right). Both frontal and lateral views of the coronary–root junction are shown.