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Comparison between Valve Sparing Aortic Root Replacement and Modified Bentall

Comparison between Valve Sparing Aortic Root Replacement and Modified Bentall .

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Comparison between Valve Sparing Aortic Root Replacement and Modified Bentall

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  1. Comparison between Valve Sparing Aortic Root Replacement and Modified Bentall Allan Stewart, MD., Jonathan A. Yang, MD; Mark J. Russo, MD/MPH; Alexander Iribarne, MD; Brendan F. Scully; Rachel Easterwood; Craig R. Smith, MD; Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY

  2. Aortic Insufficiency & Root Aneurysm • Different treatment options exist • Bentall Procedure1 • Several modifications • Valve-sparing root replacement (VSRR) • Sir MagdiYacoub, Tirone David • We have performed both at our Institution since 2005 1. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax. 23(4):338-9.

  3. Methods • Retrospective study • Peri-Operative and short-term data • VSRR via the re-implantation method described by David, et al1 • Modified Bentall Procedures – novel composite biologic graft 1. David TE, Feindel CM. An aortic valve-sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J ThoracCardiovasc Surg. 1992 April; 103(4):617-21.

  4. Valve-Sparing Root Replacement

  5. BioRoot Edwards Perimount Valve ATS 3f Valve

  6. BioRoot

  7. Results

  8. Pre-Treatment Decisions

  9. “Real-time” Repair Algorithm (AI + Aneurysm) Reimplantation Can valve be Repaired? Should it be Repaired? Repair Yes Yes Remodeling No BioRoot Should it be Replaced? Replace Yes Mechanical Conduit No Ignore

  10. When Should We Repair? • Aortic Leaflet Integrity • Reliable valve-sparing results with: • supple leaflets • normal annular size • Bicuspid and tri-leaflets have good 10-year data • High Failure Rates with: • Severe AI • Multi-leaflet Prolapse • Multiple Fenestrations

  11. When Should We Replace? • Marked leaflet Asymmetry • Multiple leaflet Fenestrations • “Broken leaflets” • Bicuspid Patients • Significant Thickening • Prolapse • Calcification • Multiple Fenestrations • Connective Tissue Patients • Data is unclear • Be cautious in repairing attenuated & severely prolapsed valves

  12. Conclusions • Similar operative times • Low rates of post-op AI, repeat AVR and mortality • Similar short-term outcomes • Reproducible and safe • Need to delineate proper guidelines for indications • Follow-up needed to assess long-term outcomes

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