Our Summary

This research paper discusses different surgical techniques used for treating problems related to the aortic valve and the ascending aorta (the main artery that carries blood away from the heart). One technique, known as the Bentall procedure, involves using a prosthetic (artificial) valve. Initially, these artificial valves were mechanical, but biological prostheses (made from human or animal tissue) were later introduced to avoid the need for patients to take anticoagulant medication long-term, which can have complications.

As more older patients need aortic root surgery, and data suggests that biological aortic valves are also useful in younger patients, the use of biological valves in the Bentall procedure has been increasing. At the same time, aortic valve-sparing (AVS) operations have been becoming more popular. These operations aim to save the patient’s own aortic valve when there is an aortic root aneurysm (a bulge or “ballooning” in the aortic root).

In recent years, there have been important advancements in this field. These include improvement and refinement of AVS techniques, a new system for classifying aortic insufficiency (a condition where the aortic valve does not close tightly), and new surgical approaches for treating cusp disease (a condition affecting the flaps of the aortic valve).

Both AVS and the Bentall procedure can effectively reconstruct the aortic root and provide good long-term results for valve durability. The AVS technique has several advantages over the Bentall procedure, including no need for taking oral anticoagulants and lifestyle adjustments. AVS operations are becoming more widely accepted as alternatives to the Bentall procedure for patients with aortic root problems. However, there is currently a lack of data comparing the safety and durability of these two approaches.

FAQs

  1. What is the Bentall and De Bono technique for aortic root replacement?
  2. What are the advantages of the aortic valve-sparing (AVS) technique over the Bentall procedure?
  3. How have the techniques for valve preserving aortic root replacement evolved over the past decade?

Doctor’s Tip

One helpful tip a doctor might tell a patient about valve replacement is to follow up regularly with your healthcare provider to monitor the function of the new valve and ensure that it is working properly. It is important to attend all scheduled appointments and follow any recommended lifestyle changes or medications to maintain the health of the valve and prevent complications.

Suitable For

Patients who are typically recommended valve replacement include those with aortic valve and ascending aorta pathologic conditions, such as aortic root aneurysms, aortic regurgitation, aortic dissection, and aortic stenosis. Patients who are at increased risk of complications from long-term anticoagulation therapy, such as older patients and younger patients with an active lifestyle, may be recommended biological valve replacements. Patients with otherwise normal aortic valves in the presence of a root aneurysm may be candidates for aortic valve-sparing operations. Additionally, patients who require aortic root surgery and are not suitable candidates for valve-sparing procedures may be recommended composite valve graft implantation. Ultimately, the decision to recommend valve replacement is based on the individual patient’s specific condition and risk factors.

Timeline

Before valve replacement:

  • Patient experiences symptoms such as chest pain, shortness of breath, fatigue, and dizziness due to aortic valve disease.
  • Diagnostic tests such as echocardiogram, cardiac catheterization, and MRI are performed to assess the severity of the valve disease.
  • Patient consults with a cardiac surgeon to discuss treatment options, including valve replacement.

After valve replacement:

  • Patient undergoes pre-operative preparation, including blood tests, imaging studies, and meeting with the anesthesia team.
  • Valve replacement surgery is performed, either with a mechanical or biological valve, using a Bentall or aortic valve-sparing technique.
  • Patient is closely monitored in the intensive care unit post-operatively for any complications.
  • Patient undergoes cardiac rehabilitation and physical therapy to aid in recovery and improve heart function.
  • Patient is followed up regularly by their cardiologist to monitor the function of the new valve and overall heart health.

What to Ask Your Doctor

  1. What is the reason for needing a valve replacement?
  2. What are the risks and benefits of a composite valve graft implantation versus an aortic valve-sparing operation?
  3. How long will the recovery process be after the surgery?
  4. What kind of follow-up care will be needed after the procedure?
  5. What are the potential complications of the surgery?
  6. Will there be a need for long-term medication after the surgery?
  7. How long can the new valve be expected to last?
  8. Are there any lifestyle changes that need to be made after the surgery?
  9. Are there any restrictions on physical activity following the surgery?
  10. What is the success rate of this type of surgery in patients with similar conditions?

Reference

Authors: De Paulis R, Scaffa R, Salica A, Weltert L, Chirichilli I. Journal: J Vis Surg. 2018 May 9;4:94. doi: 10.21037/jovs.2018.04.12. eCollection 2018. PMID: 29963383