An alternative approach to build a “biologic Bentall” from a pericardial tube and a sutureless valve

This report describes our novel technique to create a bio-Bentall from a pericardial tube and a rapid deployment valve. This technique facilitates the reimplantation of the coronary arteries as the proximal anastomosis is sewn before valve implantation and allows suturing of the coronary ostia from in- and outside as there is no interference with the implanted valve. Indications for this technique can be complex redo cases and patients with contraindications for a conventional Bentall procedure. We have applied this technique in two patients with good results.The Bentall-procedure, first described in 1968 [1], is the gold standard for patients requiring replacement of the aortic root and valve. Especially in redo cases it can be very difficult to mobilize the coronary buttons and the procedure is accompanied with substantial morbidity and mortality [2]. Various modifications of the original Bentall procedure have been published [3–5]. The novelty of our procedure is implantation of the pericardial tube and anastomosis of the coronary ostia followed by the positioning and implantation of the Intuity Elite rapid deployment valve (Edwards Lifesciences, Irvine CA, USA). This approach minimizes the need for mobilization of the coronary ostia and even allows the implantation of the conduit in an inclusion technique. As the use of the Intuity Elite valve is contraindicated in aneurysms of the aortic root or the ascending aorta this report describes an off-label use.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research