The Chrysalis Technique: A Unique New Way to Perform an Aortic Root Replacement

This article is part of CTSNet’s Guest Editor Series, “Mastering Aortic Root Surgery—Learning From Top Surgeons”. Dr. Lorena Montes invited top cardiac surgeons from around the world to contribute clinical videos on various aortic root surgery techniques. 

This is a highly novel way for performing an aortic root replacement. The main principle of this technique is that the dilated aortic root is not resected. Instead, it is opened, and the valved conduit is sutured directly to the annulus without harvesting the coronary buttons. 

After this has been performed, marks were made on the graft opposite the left and right coronary arteries. A circular hole was made next to the coronary arteries with a Bovie diathermy, and then anastomosed directly onto the graft without making any incisions into the native aorta to create buttons. This results in an in-situ anastomosis. 

The distal anastomosis was then performed, and at the end of the operation, the native aorta was wrapped around the graft like the chrysalis of a butterfly, then sutured closed. This forms a highly hemostatic additional layer around the graft. 

The major advantages of this technique over the Bentall procedure are that it is: 

• Faster—This technique avoids having to take coronary buttons. 
• Safer—This technique does not risk damaging the left and right coronary arteries when making coronary buttons. 
• More hemostatic —A whole layer of native aorta surrounds the graft, and the proximal anastomosis is inside this chrysalis, minimizing any potential oozing.  

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