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Letters to the Editor |
Department of Cardiovascular Medicine, Division of Cardiac Surgery, Ospedali Riuniti di Trieste, Ospedale di Cattinara, via P. Valdoni – 34100 Trieste, Italy
Received 3 June 2008; accepted 1 July 2008.
* Corresponding author. Tel.: +39 040 3994856; fax: +39 040 3994995. (Email: giusep.gatti{at}tiscali.it).
Key Words: Aortic aneurysm • Aortic root • Bioprosthesis
We thank Urbanski and Diegeler for their interest [1] in our report [2], and we praise their championing the so-called biologic Bentall procedure. We shall also take this opportunity to apologize to Albertini and co-workers, whose report [3] was printed right at the time our own had been accepted for publication.
In their letter Urbanski and Diegeler enlist the many advantages of sewing a prosthetic valve, be it either mechanic or biologic, inside a vascular tube graft rather than at the end of it. The senior author (BZ) learned this detail from Professor Christian Cabrol in 1985 and has been using it ever since, although in combination with the more popular Bentall–Kouchoukos technique.
Urbanski, Diegeler, and their co-workers have been successful in using a stentless bioprosthesis to accomplish this task [4,5]. We have no real disagreement with this, although we would maintain that their conduit possibly requires a little longer to be assembled compared to the use of a stented valve. We also suspect that it may be less forgiving of any small error in estimating its length, eventually jeopardizing the geometry of the valve. Finally, it is definitely too short to be bevelled and therefore it cannot help preventing eventual bends downstream. However, the large series of patients Urbanski and Diegeler have cumulated over the years stands to demonstrate that these difficulties can be successfully mastered, and we congratulate them for achieving this.
Finally, the valve-in-valve concept by transcatheter techniques has been proven for stented aortic valves that have failed. Although current endovascular technology may benefit from a rigid structure for landing we trust that in the near future it will be adapted to stentless conduits as well.
Again, we thank Urbanski and Diegeler for their constructive comments.
References
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