Delayed Two-Stage Bentall Procedure: A Safe Technique of Redo Supra-Prosthetic Aortic Root Replacement

Background: Patients presented for complicated redo surgery after previous aortic valve replacement with the indication for aortic root repair due to dilatation or aneurysm. In those cases where the prosthetic aortic valve is in good condition, a valve-sparing procedure might simplify the complicated surgery. The aim of this case series paper is to describe a technique and to show the results of repairing the aortic root without compromising the previously inserted, well-functioning mechanical aortic valve. Methods: Between March 2017 and May 2017, 11 patients underwent re-sternotomy with placement on cardiopulmonary bypass with cardiac arrest and exposure of the aortic root. After the aortotomy, the aortic valve was inspected. Subsequently, the aortic sinuses were resected, sparing the coronary ostia buttons. A prosthetic tube was implanted above the preexisting valve. Finally, the coronary ostia were reattached to the tube, turning this procedure into a complete Bentall. Results: Echocardiography demonstrated fully functional valves and well-implanted aortic prosthesis. All patients were discharged within ten days post-surgery without any adverse events. Conclusions: The delayed two-stage Bentall procedure is a feasible and safe technique that preserves pre-implanted valves and does not cause any distortion of the aortic annulus.