Dilatation of the aortic root
In patients with aortic root dilatation the aortic valve reimplantation (David procedure) was performed [10]. Briefly, a Dacron straight graft (Hemashield, Maquet, Germany) was used for the David procedure. The Dacron graft was sized according to the formula (leaflet height in mm × 1.5) + 2 mm. Over the years we modified the David procedure: we placed three stitches at the annular base of the Dacron graft creating pseudoneosinuses and later we added three additional stitches at the level of the commissures to create a neosinus in order to obtain a more physiological shape [11].
The repaired BAV was assessed by intraoperative transoesophageal echocardiography. Anticoagulation was not required postoperatively except in case of atrial fibrillation or history of pulmonary embolism.