Aortic valve sparing operations were developed to preserve the aortic valves during surgery for aortic root aneurysm or ascending aortic aneurysms with aortic insufficiency (AI). There are basically two types of aortic valve sparing operations for aortic root aneurysms: reimplantation of the aortic valve (David operation) and remodeling of the aortic root (Yacoub operation). In our original description of reimplantation of the aortic valve we used a straight tubular Dacron graft and implanted

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... e aortic valve inside of it. Over the years, this operation was modified to create neo-aortic sinuses. A graft 4 to 6mm larger than needed is selected, and the end that is used to be secured below the aortic annulus is plicated at three places, each one corresponding to the lowest portion of the aortic annulus. These 3 plications create a curvilinear base for the nadir of the aortic annulus and remnants of the sinus to lie upon. After the aortic valve is suspended inside the graft, darts are placed in between the commissures with a continuous polypropylene suture to narrow the diameter of the sinotubular junction and create neo-aortic sinuses.