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.