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Letters to the Editor |
Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, 97616 Bad Neustadt, Germany
Received 28 May 2008; accepted 1 July 2008.
* Corresponding author. Address: Herz- und Gefaess-Klinik, Salzburger Leite 1, 97616 Bad Neustadt, Germany. Tel.: +49 9771 662416; fax: +49 9771 651219. (Email: p.urbanski{at}kardiochirurg.de).
Key Words: Bentall operation • Self-assembled composite grafts
In the September 2007 and April 2008 issues of the European Journal of Cardio-thoracic Surgery two ‘how-to-do-it’ papers about modified, self-assembled composite grafts for the Bentall operation appeared [1,2], which we read with great interest. Using different prostheses but almost identical surgical techniques, the authors performed complete aortic root replacement with self-assembled composite grafts in which biological valve prostheses were located inside the vascular tubes. With their small but very positive experiences in using this technique that we have used routinely for almost 10 years, the authors confirm excellent reproducibility and suitability of biological valved conduits for modified Bentall procedure. As we reported previously, and the authors of current articles also observed in their experiences, these conduits offer a width of advantages; for example, the possibility of valve oversizing, the ability to anastomose the conduit to an altered annulus, and especially, the potential facilitation of replacing biological valve prostheses [3–5].
On the basis of more than 500 such procedures using different prostheses, we are now able to state that each vascular graft and each valvular prosthesis (mechanical or biological) can be used for assembling valved composite grafts, of which the most important characteristics are: (1) placing the valve prosthesis inside the graft, leaving a rim of the Dacron tube beneath the valve prosthesis for anastomosing to the annulus, (2) implanting the graft supra-annularly by passing the sutures through the end of the Dacron tube rather than through the sewing ring of the valve prosthesis, and (3) reimplanting the coronary ostia end-to-side directly in the button-technique.
Of particular importance regarding the self-assembled composite grafts with biological valve prostheses located inside the vascular grafts is their potential for simplifying the valve re-replacement. In contrast to biological full-root grafts, the Dacron wall of the composite graft does not calcify enabling replacement of the valve prosthesis, which is sutured to the vascular tube rather than to the aortic annulus. However due to a bulky sewing ring, removal of the stented valve prosthesis can be difficult, and therefore we preferred using the stentless valves in which either the complete valve or even only the valve cusps could be resected. Moreover, considering the development of new technologies, use of the stentless valve composite grafts would also enable valve-to-valve implantation using minimal invasive (transcutan or transapical) techniques.
Footnotes
The authors of ref. [1] were also invited to comment on this Letter to the Editor but declined the offer.
References
This article has been cited by other articles:
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  G. Gatti, B. Benussi, A. Pappalardo, and B. Zingone Reply to Urbanski and Diegeler Eur. J. Cardiothorac. Surg., October 1, 2008; 34(4): 927 - 927. [Full Text] [PDF]
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