**5.3 Impact of the vascular prosthesis**

De Paulis and colleagues showed that early valve motion after re-implantation inside the Valsalva prosthesis was similar to those of normal subjects, with graft distensibility being retained at the neosinuses [26]. At late follow-up, the elasticity of the graft's sinuses were also to an extent maintained, with the graft reponding to the changes in pressure between systole and diastole [27]. Further studies may elucidate any haemodynamic or clinical differences between techniques used to create neosinuses. Implantation of the Valsalva prosthesis removes the need to fashion neosinuses from a tube graft, which may prove advantageous by reducing aortic cross clamp times in cases where the aortic pathology extends into the aortic arch requiring complex reconstruction.
