I. DATA AND METHODS Clinical data From June 2003 to December 2007, a total of 212 aortic valve replacement surgeries were performed, of which 18 cases (8.4%) were reconstructed by aortic annuloplasty. There were 10 cases of males and 8 cases of females. Age ranged from 12 to 71 years, with an average of 54.9 years. There were 5 cases of congenital lesions, among which two children who were proposed to undergo Ross surgery gave up Ross surgery due to poor development of the autogenous pulmonary valve and underwent aortic valve replacement instead. There were 3 cases of perivalvular abscess caused by endocarditis, 8 cases of severe calcification through the wall, 2 cases of degenerative lesions in the elderly, 14 cases of NYHA class 3 cardiac function, and 4 cases of class 2. Methods Surgery was performed under general anesthesia and shallow hypothermia extracorporeal circulation. Myocardial protection was retrograde perfusion of HTK fluid (40 ml/kg) through the coronary sinus. Routine left heart cannulation was performed. After blocking the aorta, the lesion was first explored through a transverse 2M incision 1M above the junction of the uncinate sinus and the right coronary sinus. After confirming that it was not possible to routinely insert a valve of the appropriate size, annuloplasty and expanded angioplasty were performed as follows. There were no surgical deaths in this group. One patient with endocarditis had cerebral infarction and acute renal failure 4 days after surgery, and was discharged from the hospital 3 weeks after surgery after improving with dialysis and other treatments. There were 2 cases of pediatric patients with autologous valve annulus at 14M and 15M respectively, which were implanted with 19# and 21# supra-annular valves respectively after treatment with good results. The aortic block time of the whole group ranged from 48 to 129 min, with a mean of (68.4±48.7). The aortic annulus was straight through 14-21L (mean 18.34±3.12) before wood, and 21-25L (mean 23.12±2.48) after reconstruction, and all of them were implanted with 19#-23# aortic valves. In the 6-month postoperative review, the peak transvalvular pressure difference (ΔP), left ventricular end-diastolic diameter (LVEDD), and peak velocity (PV) of the aortic valves were significantly different from those of the preoperative valves (P<0.01) (Table 1). There was no perivalvular leakage, hemolysis, and recurrent infection.NYHA cardiac function was in grade 1-2.3 DISCUSSION There are several issues that surgeons are concerned about in aortic replacement. 1. Whether the implanted valve is the right size. If a small valve is chosen, it will inevitably result in a high transvalvular pressure difference between the left ventricle and the aorta after surgery. It is not conducive to the recovery of the left ventricle, and even the aggravation of left ventricular hypertrophy. 2, the problem of bleeding. Especially in patients with narrow valve annulus and severe aortic tissue lesions, excessive anastomotic tension often leads to severe bleeding from the anastomosis, and sometimes even re-blocking hemostasis or replacement of the prosthesis. 3. Perivalvular leakage or recurrent infection. It often occurs in patients with a history of endocarditis, and incomplete clarification of the diseased tissue leads to postoperative recurrence. 4, Coronary artery blood flow obstruction. Some patients have abnormal coronary artery openings, some of which are close to the aortic ridge at the junction of the valve or close to the valve ring and the sinus is not enlarged. The use of supra-annular valves at this time may affect the opening of the coronary artery and cause serious consequences. In this group of patients, the aortic root cannot be routinely replaced either because the annulus is too small (as in the two cases of aortic replacement in children) or because of severe aortic root pathology such as calcification and abscess, and the general method of annular expansion does not completely eliminate complications such as those brought about by severe calcification or abscess. Only thorough debridement of the diseased aortic root, reconstruction of the left ventricular outlet, and valve replacement are reliable. The results of this group of surgeries show that the use of special techniques in special patients not only effectively enlarges the annulus, but also completely removes the diseased tissue, and the results of suture closure are accurate, which is of value in the surgery of patients with certain special conditions.