Early results of a modified biological valved conduit for the Bentall procedure

Abstract

Introduction: Few bioprosthetic valved conduits for aortic root surgery are commercially available. Long-term Warfarin therapy (mechanical), potential root calcification (xeno-or homograft valves), and the need for additional ascending aorta grafts are concerns associated with currently used valved conduits. A simplified, selfassembled bioroot conduit comprising currently available materials that facilitates future intervention and exhibits advantages of a bioprosthesis was used. , 17 consecutive patients underwent urgent or elective aortic root surgery. A bioroot conduit, constructed using 28 or 30 mm of sinus of Valsalva Gelweave tube graft and a 3 to 5 mm smaller bioprosthetic Trifecta valve sewn into the sinus of Valsalva base, was preconstructed in the operating room before sternotomy. The size of the valved conduit was based on the distal ascending aorta or proximal arch and not aortic annular dimension. The bioroot was sutured to the native aortic annulus at the level of the bottom skirt of the Valsalva graft without contacting the sewing cuff of the bioprosthetic valve.Results: All patients survived the operation and were discharged home without longterm anticoagulation therapy. The mean age was 65 ± 12 years, and 13 patients were male. The cardiopulmonary bypass duration was 169 ± 84 minutes, and the crossclamp (XC) duration was 110 ± 32 minutes. The operation was elective in 12 patients, urgent/emergent in five, and redo in three. Conclusion:A simplified self-assembled bioroot Bentall conduit is appropriate for aortic root reconstruction. Use of a patient-tailored valved conduit will not prolong the cardiac ischemic time and will facilitate future valve replacement. K E Y W O R D Saorta and great vessels, aortic root surgery, bioprosthesis, bioroot Bentall

Modified Bentall procedure: A 15-year single-center clinical experience

“…3,4 Until now, there are numerous modifications of the original Bentall procedure to reduce postoperative bleeding and other conduit-related complications. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Among those, Kouchoukos et al 5 described the "button technique" in which two coronary ostia were detached, adequately mobilized, and reattached to the conduit. This modified technique has been shown to reduce the risk of pseudoaneurysm in the proximal anastomosis and coronary ostia due to suture dehiscence.…”