Modified Bio-Bentall Operation with a Rapid Deployment Valve

P0220 

Case Video Submission 

Hyo Kyen Park (1), Hong Rae Kim (2), Byeong A Yoo (3), Joon Bum Kim (4)

(1) Asan Medical Center, Seoul, (2) Asan Medical Center, Gangnamgu, Seoul, (3) Asan medical center, Seoul, Korea, Republic of, (4) Asan Medical Center, Seoul, Na

Hyo Kyen Park    -  Contact Me
Asan Medical Center

Hong Rae Kim    -  Contact Me
Asan Medical Center

Byeong A Yoo    -  Contact Me
Asan medical center

*Joon Bum Kim    -  Contact Me
Asan Medical Center

Hyo Kyen Park    -  Contact Me
N/A

Objective
While the Bentall operation is regarded as the standard therapy for aortic root surgery, it poses challenges in cases of vulnerable aortic tissue, such as infective endocarditis, Behcet's disease, or acute aortic dissection. These conditions are associated with an increased risk of prosthesis detachment, leading to significant morbidity and mortality. In this study, we present a modified Bio-Bentall technique using a rapid deployment valve (RDV).

Case video summary
After establishing cardiopulmonary support and aortic cross-clamping, the aortic roots were resected to the level of the aortic valve annulus, and coronary buttons were mobilized. A 30-mm Valsalva graft was folded and inserted into the left ventricular outflow tract, followed by a double-layer continuous suture. The graft was withdrawn, and valve size was decided. After successfully anastomosing the left coronary artery, the RDV was introduced, guided by the suture, and carefully deployed to ensure the expandable frame was positioned below the proximal end of the graft.
Surgery was performed in 13 patients (median age 69 years, IQR 67-75) by a single surgeon between January 2018 and December 2022. The median cardiopulmonary bypass time and aortic cross-clamping time was 99.0 minutes (IQR 81-120), and 73.0 minutes (IQR 60-90), respectively. Among these, 5 (38.5%) required emergent or urgent operations. There were no early mortality. Over a 10-month period of echocardiographic follow-up (IQR 6-13), no prosthetic aortic valve insufficiency was observed.

Conclusions
Our initial experiences with the modified Bio-Bentall operation using a RDV have demonstrated positive early outcomes in high-risk candidates. However, these results should be further validated with larger datasets and long-term follow-up data.

Aortic Root