**8. Subvalvular aortic annuloplasty for isolated aortic insufficiencies**

Principle of isolated aortic valve repair associates cusp repair (alignment of cusp free edge + effective height resuspension) with subvalvular aortic annuloplasty. The expansible aortic ring is of an open configuration in order to allow placement below the coronary arteries without detaching them from the aortic wall (Lansac et al., 2011a, 2011b).

#### **8.1 Transection of the aorta and dissection of the aortic root down to the subvalvular plane**

The aorta is completely transsected 1 cm above the sino-tubular junction. External dissection of the aortic root down to the aortic annular base is performed, passing under the coronary arteries, without detaching them from the aortic wall. The external aspect of the aortic wall is dissected free from the pulmonary artery and infundibulum and from the roof of the left atrium, in order to reach the subvalvular plane. The internal aortic annular base diameter is measured with Hegar dilators. It is the sole criterion to determine the size of the expansible external subvalvular aortic ring, which is downsized by one size (CORONEO, Inc.).
