In the small aortic root, extremely weakened tissue and extensive calcification predispose toward the implantation of small prostheses, anastomotic bleeding, and paravalvular leaks. We describe a procedure in which a "homemade" composite mechanical prosthesis-conduit is implanted in a supra-annular position in two patients with a small aortic root. This technique facilitates the placement of a larger prosthesis, thus avoiding patient-prosthesis mismatch. doi: 10.1111/jocs.12741 (J Card Surg 2016;31:309-310).
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