Conclusions
Although out-of-recommendation, the presented technique is a bailout
strategy to implant a Perceval valve after a hockey-stick aortotomy.
Indeed, in case of unexpected small annuli or when a closer approach to
the annulus is needed, a conventional extended aortotomy does not
preclude the Perceval valve option as long as the aortic root integrity
is simmetrically rebuilt. In our experience, the technique is safe and
effective and it might potentially extend the use of that sutureless
valve option.