Bentall procedure for reoperation in the small aortic root or annulus_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Yu , SONG Laichun , WANG Bo ,  TAO Liang

Department of Cardiac Surgery, Asia Heart Hospital, Wuhan, 430022, P. R. China;

Corresponding author：

TAO Liang, Email: taoliangmd@sina.com

Keywords：

Bentall; small aortic root; reoperation

DOI：

10.7507/1007-4848.202011061

Video：

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Objective To investigate and evaluate the safety and efficacy of Bentall operation in the reoperation of patients with small aortic root or annulus.Methods Bentall procedure was performed in 24 patients with small aortic root or annulus in our hospital from September 2014 to December 2019. There were 18 males and 6 females with a mean age of 31-68 (45.70±15.27) years. All patients had undergone a previous replacement of the aortic valve including 20 patients receiving valve replacement, 2 patients aortic root replacement with a valved conduit and 2 patients bioprothesis replacement.Results There was no early death in hospital and one death during the 30-day postoperative period. Re-thoracotomy due to bleeding was necessary in only 2 patients and no bleeding was related to the proximal anastomosis of the conduit. One patient performed pacemaker implantation for heart block after the procedure. The mean sizes of implanted aortic valve prosthesis were 22.75±1.78 mm. A mean gradient across the aortic valve prostheses in the postoperative echocardiographic examination was 11.17±2.24 mm Hg.Conclusion Bentall procedure is safe and allows a larger size of prosthesis implantation in patients with small aortic annulus or root after previous aortic valve or complete root replacement, resulting in good postoperative hemodynamic characteristics and short-term clinical results.

Citation： LI Yu, SONG Laichun, WANG Bo, TAO Liang. Bentall procedure for reoperation in the small aortic root or annulus. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(5): 592-596. doi: 10.7507/1007-4848.202011061 Copy

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2.	Florath I, Albert A, Rosendahl U, et al. Mid term outcome and quality of life after aortic valve replacement in elderly people: Mechanical versus stentless biological valves. Heart, 2005, 91(8): 1023-1029.
3.	Doss M, Martens S, Wood JP, et al. Performance of stentless versus stented aortic valve bioprostheses in the elderly patient: A prospective randomized trial. Eur J Cardiothorac Surg, 2003, 23(3): 299-304.
4.	Sommers KE, David TE. Aortic valve replacement with patch enlargement of the aortic annulus. Ann Thorac Surg, 1997, 63(6): 1608-1612.
5.	Mizoguchi H, Sakaki M, Inoue K, et al. Mid-term results of small-sized St. Jude Medical Regent prosthetic valves (21 mm or less) for small aortic annulus. Heart Vessels, 2013, 28(6): 769-774.
6.	El-Hamamsy I, Ibrahim M, Stevens LM, et al. Early and long-term results of reoperative total aortic root replacement with reimplantation of the coronary arteries. J Thorac Cardiovasc Surg, 2011, 142(6): 1473-1477.
7.	Jassar AS, Desai ND, Kobrin D, et al. Outcomes of aortic root replacement after previous aortic root replacement: The "true" redo root. Ann Thorac Surg, 2015, 99(5): 1601-1608.
8.	Garrido-Olivares L, Maganti M, Armstrong S, et al. Clinical outcomes of aortic root replacement after previous aortic root replacement. J Thorac Cardiovasc Surg, 2013, 146(3): 611-615.
9.	Bahlmann E, Cramariuc D, Minners J, et al. Small aortic root in aortic valve stenosis: Clinical characteristics and prognostic implications. Eur Heart J Cardiovasc Imaging, 2017, 18(4): 404-412.
10.	Levy D, Garrison RJ, Savage DD, et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med, 1990, 322(22): 1561-1566.
11.	Harky A, Wong CHM, Hof A, et al. Stented versus stentless aortic valve replacement in patients with small aortic root: A systematic review and meta-analysis. Innovations (Phila), 2018, 13(6): 404-416.
12.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2017, 70: 252-289.
13.	Pepper J, Cheng D, Stanbridge R, et al. Stentless versus stented bioprosthetic aortic valves: A consensus statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2008. Innovations (Phila), 2009, 4(2): 49-60.
14.	Yakut C. A new modified Bentall procedure: The flanged technique. Ann Thorac Surg, 2001, 71(6): 2050-2052.
15.	Albertini A, Dell'Amore A, Zussa C, et al. Modified Bentall operation: The double sewing ring technique. Eur J Cardiothorac Surg, 2007, 32(5): 804-806.
16.	González Rocafort Á, Aroca Á, Polo L, et al. Chimney technique for mitral valve replacement in children. Ann Thorac Surg, 2013, 96(5): 1885-1887.

1. Pibarot P, Dumesnil JG. Prosthesis-patient mismatch: Definition, clinical impact, and prevention. Heart, 2006, 92(8): 1022-1029.
2. Florath I, Albert A, Rosendahl U, et al. Mid term outcome and quality of life after aortic valve replacement in elderly people: Mechanical versus stentless biological valves. Heart, 2005, 91(8): 1023-1029.
3. Doss M, Martens S, Wood JP, et al. Performance of stentless versus stented aortic valve bioprostheses in the elderly patient: A prospective randomized trial. Eur J Cardiothorac Surg, 2003, 23(3): 299-304.
4. Sommers KE, David TE. Aortic valve replacement with patch enlargement of the aortic annulus. Ann Thorac Surg, 1997, 63(6): 1608-1612.
5. Mizoguchi H, Sakaki M, Inoue K, et al. Mid-term results of small-sized St. Jude Medical Regent prosthetic valves (21 mm or less) for small aortic annulus. Heart Vessels, 2013, 28(6): 769-774.
6. El-Hamamsy I, Ibrahim M, Stevens LM, et al. Early and long-term results of reoperative total aortic root replacement with reimplantation of the coronary arteries. J Thorac Cardiovasc Surg, 2011, 142(6): 1473-1477.
7. Jassar AS, Desai ND, Kobrin D, et al. Outcomes of aortic root replacement after previous aortic root replacement: The "true" redo root. Ann Thorac Surg, 2015, 99(5): 1601-1608.
8. Garrido-Olivares L, Maganti M, Armstrong S, et al. Clinical outcomes of aortic root replacement after previous aortic root replacement. J Thorac Cardiovasc Surg, 2013, 146(3): 611-615.
9. Bahlmann E, Cramariuc D, Minners J, et al. Small aortic root in aortic valve stenosis: Clinical characteristics and prognostic implications. Eur Heart J Cardiovasc Imaging, 2017, 18(4): 404-412.
10. Levy D, Garrison RJ, Savage DD, et al. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med, 1990, 322(22): 1561-1566.
11. Harky A, Wong CHM, Hof A, et al. Stented versus stentless aortic valve replacement in patients with small aortic root: A systematic review and meta-analysis. Innovations (Phila), 2018, 13(6): 404-416.
12. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2017, 70: 252-289.
13. Pepper J, Cheng D, Stanbridge R, et al. Stentless versus stented bioprosthetic aortic valves: A consensus statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2008. Innovations (Phila), 2009, 4(2): 49-60.
14. Yakut C. A new modified Bentall procedure: The flanged technique. Ann Thorac Surg, 2001, 71(6): 2050-2052.
15. Albertini A, Dell'Amore A, Zussa C, et al. Modified Bentall operation: The double sewing ring technique. Eur J Cardiothorac Surg, 2007, 32(5): 804-806.
16. González Rocafort Á, Aroca Á, Polo L, et al. Chimney technique for mitral valve replacement in children. Ann Thorac Surg, 2013, 96(5): 1885-1887.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Bentall procedure for reoperation in the small aortic root or annulus

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