Mini-Bentall Procedure and Hemiarch Replacement: The “French Cuff” Technique

In this video, the fourth in a seven-part series, Tristan Yan demonstrates how to perform a proximal annular anastomosis using the “French Cuff” technique to ensure absolute hemostasis.

1. Horizontal mattress sutures are placed neatly below the aortic annulus. 2-0 Ethibond Excel annular sutures with pledgets are used and the sutures are evenly distributed.
2. The annulus is sized and an appropriate prosthetic valve is selected, as in a routine aortic valve replacement. It is advisable not to oversize the valve.
3. A Valsalva graft (Vascutek Ltd, Renfrewshire, Scotland) is selected according to this formula: Valsalva Graft Size = Aortic Valve Size + 5 mm.
4. The proximal cuff of the Valsalva graft is trimmed down to 8 mm. This cuff is folded back over the outside of the Valsalva portion of the graft to make a double cuff, hence the “French Cuff”’ technique.
5. The prosthetic valve is positioned inside of the Valsalva graft. The annular sutures are passed through the sewing ring of the prosthesis first and then the folded proximal edge of the Valsalva graft.
6. Once all the sutures are passed through, the valve and the graft are parachuted down onto the annulus.
7. The sutures are tied and cut one by one around the sewing cuff. This completes the first proximal layer of the “French Cuff” anastomosis.

View all videos in this series here.