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Brain & Heart Prosthesis-sparing aortic root replacement

A B apical ventricular vent through small left thoracotomy may
be an easy and safe option to address these issues.
If prosthetic valve replacement is not required, the
completion Bentall procedure serves as an appropriate
option, sewing a prosthetic graft to the sewing ring of the
previously implanted prosthetic valve. If the graft is large
enough to completely cover the prosthetic valve cuff,
C D suture line reinforcement with the aortic wall remnant is
not necessary to reduce the risk of bleeding, as previously
reported. The importance of measuring the true outer
1-3
diameter of the prosthetic valve was highlighted in the
literature. In an in vivo setting, the outer diameter of a
10
prosthetic valve can be slightly larger than that obtained
from the commercially available chart. In our case, the outer
diameter of a 25-mm REGENT valve is 33 mm according
Figure 2. (A) The whole adventitia of the non-aortic sinus disappeared, to the chart; however, it was found to be slightly larger than
and the polyester fabric was solely exposed. (B) The outer diameter of that of a 33-mm cylindrical valve sizer (Figure 2B). As a
the 25-mm REGENT valve was found to be slightly larger than that of result, a 34-mm or larger graft was considered appropriate
®
a 33-mm cylindrical valve sizer. (C) A 28-mm Gelweave Valsalva was
®
cut at the middle of its skirt portion, through which these sutures were to completely house the prosthetic valve cuff, and a 28-mm
passed. (D) The graft was seated to completely cover the valve cuff. Valsalva graft was chosen since its diameter is 36 mm at the
midlevel of its skirt portion.
most of the cases of aortic root reoperation after AVR,
but pseudoaneurysm was less common in the literature. 4. Conclusion
3,4
There have been reports on pseudoaneurysms arising The completion Bentall procedure is considered a feasible
from the previous suture lines; however, the ones caused technique for reoperative root replacement in patients
by aortic root rupture from repeat aortic dissection which with a prosthetic aortic valve following acute type A aortic
was repaired with the completion Bentall procedure have dissection repair. It is important to accurately measure the
rarely been reported. According to the three contemporary outer diameter of the prosthetic valve to ensure proper fit
studies on reoperative aortic root surgery after previous of the graft and to minimize the risk of bleeding.
acute type A dissection repair, 26 cases out of total
82 patients (31.7%) were operated on due to aortic root Acknowledgments
pseudoaneurysm. However, completion Bentall procedure None.
was not implemented in any of these cases. 5-7
In the previous operation, the dissected aortic layers Funding
of our patient had been attached with a polyester fabric None.
inserted between the layers and secured with BioGlue.
Although there have been reports suggesting a possible Conflict of interest
association between aortic dissection and an inflammatory
reaction caused by BioGlue, it remains unclear whether The authors declare no conflicts of interest.
8,9
the recurrent dissection of the sinus of Valsalva might have Author contributions
been caused by BioGlue, as there were no findings attesting
to the causal relationship. Conceptualization: Hisato Ito
In cases of a huge pseudoaneurysm, where massive Investigation: Hisato Ito, Satoshi Maruyama, Takato
hemorrhage is likely to occur during redo sternotomy and Yamasaki, Saki Bessho, Shuhei Toba, Yu Shomura
the degree of adhesion around the previous ascending Supervision: Motoshi Takao
graft is unknown, ventricular fibrillatory arrest along Writing – original draft: Hisato Ito
with hypothermic circulatory arrest offers a safe option Writing – review & editing: Motoshi Takao
for cross-clamping the ascending graft. In the setting of Ethics approval and consent to participate
a mechanical valve, aortic regurgitation and subsequent
ventricular overdistention caused by the continuous flow A written informed consent was taken from the patient
of cardiopulmonary bypass should be considered. An before participation.

Volume 2 Issue 1 (2024) 3 https://doi.org/10.36922/bh.2256