Replacement of the aortic root by composit graft valve: Bentall procedure and its modifications

Replacement of the aortic root by composite-graft valve is the most frequently used procedure for surgical treatment of dilation of aortic annulus, sinuses of Valsalva and tubular part of ascending aorta. Crucial part of the surgical procedure is the reestablishment of the coronary flow with one of the following methods: classic, Cabrol and so-called "button" technique. We have retrospectively evaluated 116 consecutive patients with aortic root replacement by composite-graft valve in a period from January 1996 to February 2002. We have applied several techniques for the restoration of coronary flow. Thirty-five patients (30%) underwent concomitant cardiac procedure, most frequently aorto-coronary bypass, whereas 7 patients had REDO operation. Deep hypothermic circulatory arrest was applied in 64 patients (55%) with acute dissection of the aorta or in cases of aortic arch resection. Classic Bentall procedure was performed in 4 patients, "button" technique in 97 patients and Cabrol (Cabrol II or modified) in 15. Total in-hospital mortality was 8.6% (10 patients). Perioperative complications occurred in 32 cases (27.5%), including early re-thoracotomy for excessive bleeding in 5 patients (4.3%). With the use of modern principles of aortic surgery, complex reconstructions of aortic root by composite-graft valve can be done with relatively low morbidity and mortality.