Cryo Preserved Allografts (Homograft) : As these are not mounted, a free hand suturing in two layers has to be done. The valve is thawed by protocol. The septal muscle is excised with support from index finger inserted through the allograft. Excess aorta is also trimmed off leaving smallstrip of aorta above each commissure. The valve is inserted into the left ventricle. With continuous prolene sutures, it is fixed in the sub annular position. The allograft is then pulled into the aorta from LV to its normal position. Using 4'0' prolene sutures, a second row of continuous running sutures are applied; tied and cut off.
For an allograft, the chosen size has to be correct as otherwise aortic regurgitation can occur. At the end of surgery, Tran's oesophageal echo is mandatory.