A case report of valve-sparing aortic root replacement in a patient with full metal jacket aorta

Abstract

With the spread of thoracic endovascular aortic repair (TEVAR), open conversions in the remote period have increased. We present a case of a 61-year-old male patient who had aortic root dilatation with aortic regurgitation and previous ascending aortic replacement for acute aortic dissection and zone 0 TEVAR with the chimney stent graft into the brachiocephalic artery with a bypass between bilateral carotid arteries.The patient was successfully treated with valve-sparing aortic root replacement and arch replacement. The chimney stent graft was entirely removed, and the proximal part of the primary aortic stent graft was also cut out. The distal side of the aortic arch was reconstructed using Vascutek Siena TM Collared Branched Graft (Terumo Vascutek, Tokyo, Japan). The cause of aortic valve insufficiency was not only root dilatation but also rupture of fenestration in the left coronary cusp. The aortic root was reconstructed using the reimplantation technique with Gelweave TM Valsalva Graft (Terumo Vascutek, Tokyo, Japan), and the left coronary cusp was repaired using the free margin resuspension technique. The postoperative course was uneventful, and at a one-year follow-up, the patient was free of complications. Because reoperation of post-TEVAR could be difficult due to unusual vascular structures, careful application of TEVAR for the aortic arch is required.

Reflecting on the lessons learned in Bologna: Surgery of the Thoracic Aorta

“…The case report by Kawatou et al (4) highlighted their valve-sparing aortic root replacement and TAR experience in a 61-year-old patient with aortic root dilatation with aortic regurgitation. This patient previously had an ascending aortic replacement for acute aortic dissection and zone 0 TEVAR with the chimney stent graft into the brachiocephalic artery with a bypass between bilateral carotid arteries.…”

“…The patient was complicationfree at 1-year follow-up. The authors emphasised the importance of securing a safe arterial cannulation site, matching the diameter of the stent graft and the artificial graft in anastomosis, ensuring that the timing of the root reconstruction is optimal, and the careful utilisation of TEVAR for aortic arch pathology (4).…”