Completion Bentall procedure for a huge aortic root pseudoaneurysm after surgery for acute aortic dissection: A case report
A 56-year-old man with a history of emergency ascending aortic and aortic valve replacement for acute type A aortic dissection 6 months previously developed a huge pseudoaneurysm arising from the sinus of Valsalva due to recurrent aortic root dissection. The patient urgently underwent the completion Bentall procedure with coronary artery reconstruction using interposing grafts. During surgery, the non-coronary sinus of Valsalva was repeatedly dissected and ruptured, where surgical glue was applied in the previous operation. The 25-mm REGENT mechanical valve® from the previous operation was left in place, and 2-0 bladed mattress sutures were circumferentially placed in the sewing ring of the prosthesis. A 28-mm Valsalva graft® was cut at the middle of its skirt portion, through which these sutures were passed and tied, and was seated to completely cover the valve cuff. The completion Bentall procedure is considered a feasible technique for reoperative aortic root replacement in patients with a prosthetic aortic valve following acute type A aortic dissection repair. It is important to accurately measure the outer diameter of the prosthetic valve to ensure proper fit of the graft and to minimize the risk of bleeding.
- Pacini D, Villa E, Martin-Suarez S, Bartolomeo RD. Aortic root substitution after aortic valve replacement: A prosthesis-sparing operation. Eur J Cardiothorac Surg. 2005;27(4):717-719. doi: 10.1016/j.ejcts.2005.01.031
- Malekan R, Spielvogel D, Saunders PC, Lansman SL, Griepp RB. The completion bentall procedure. Ann Thorac Surg. 2011;92(1):362-363. doi: 10.1016/j.athoracsur.2011.02.078
- Idhrees AM, Velayudhan B, Jacob A. Prosthetic valve sparing aortic root replacement-A persuasive option in well-functioning aortic valve prosthesis. J Card Surg. 2021;36(5):1786-1792. doi: 10.1111/jocs.15402
- Dun Y, Shi Y, Guo H, et al. Outcome of reoperative aortic root or ascending aorta replacement after prior aortic valve replacement. J Thorac Dis. 2021;13(3):1531-1542. doi: 10.21037/jtd-20-3081
- Ellauzi H, Zafar MA, Wu J, et al. Fate of preserved aortic root following acute type A aortic dissection repair. Semin Thorac Cardiovasc Surg. 2022;34(2):419-427. doi: 10.1053/j.semtcvs.2021.04.002
- Ohira S, Malekan R, Kai M, et al. Aortic reoperation after prior acute type A aortic dissection repair: Don’t despair the repair. Ann Thorac Surg. 2023;116(1):43-50. doi: 10.1016/j.athoracsur.2022.10.021
- Pedroza AJ, Dalal AR, Krishnan A, et al. Outcomes of reoperative aortic root replacement after previous acute type A dissection repair. Semin Thorac Cardiovasc Surg. 2023:S1043-0679(23)00016-3. In Press. doi: 10.1053/j.semtcvs.2023.02.001
- Kobayashi T, Kurazumi H, Sato M, Gohra H. Pseudoaneurysm rupture after acute type A dissection repair: Possible reaction to BioGlue. Interact Cardiovasc Thorac Surg. 2018;26(2):331-332. doi: 10.1093/icvts/ivx331
- Luk A, David TE, Butany J. Complications of bioglue postsurgery for aortic dissections and aortic valve replacement. J Clin Pathol. 2012;65(11):1008-1012. doi: 10.1136/jclinpath-2012-200809
- Henmi S, Scaffa R, Folino G, De Paulis R. Simple completion bentall procedure of preserving aortic bioprosthesis after aortic valve replacement. JTCVS Tech. 2022;14:66-68. doi: 10.1016/j.xjtc.2022.04.020