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Furthermore, the expanded skirt reduces the distance and the tension on the coronary button anastomosis, increasing safety and possibly reducing complication rates. This review demonstrates the versatility of the Valsalva graft in various scenarios of aortic root surgery, with special emphasis on different uses of the skirt and the collar. Surgery involving the biliary tree is common but has the potential for serious complications. Adjuncts such as intraoperative cholangiogram and, more recently, indocyanine green (ICG) fluorescence cho