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.