HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Massimo Massetti Gerard Babatasi Andre Khayat Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Massetti, M. Articles by Khayat, A. Search for Related Content PubMed Articles by Massetti, M. Articles by Khayat, A. Related Collections Great vessels Valve disease Related Article

Ann Thorac Surg 2002;73:694-695
© 2002 The Society of Thoracic Surgeons

---

Correspondence

Dilated aortic root and stentless valve implantation: Reply

^a Thoracic and Cardiovascular Surgery Department, University Hospital, CHU avenue de la "Cote de Nacre", 14033 Caen, France

e-mail: massetti-m{at}chu-caen.fr

To the Editor

We thank The Annals for the opportunity to reply to the letter of Dr Siebenmann who shares our concern regarding the use of a stentless implant in a dilated aorta. Unlike stented valves, implantation of stentless aortic valves requires close attention to aortic anatomy. To prevent aortic insufficiency, the relationship between the annulus and sinotubular ridge must be closely adjusted. Dilation of the sinotubular ridge allows commissures to splay apart to cause central aortic insufficiency. As we know, there are many physio-pathological situations that affect the geometry of the sinotubular junction, and different surgical techniques are used to insert stentless implants in these situations.

When the aortic root is globally dilated, the excess tissue can be reduced by resecting it or by plication sutures placed in the dilated sinuses (creating pleats). Moreover, a strip of Teflon felt can be sutured at the level of the sinotubular junction to prevent further dilatation. This technique has been suggested by Petracek and colleagues [1], and it appeared very similar to that recommended by Siebenmann and associates [2] in which the excess tissue was resected and not plicated at the level of the T-shaped incision followed by external polyester net reinforcement.

In the case of an isolated ascending aortic aneurysm, the sinotubular junction is sometimes enlarged but is not pathological. As we have recommended [3], replacement of the aneurysm with a tubular graft easily remodels the sinotubular junction. Aneurysmal and atherosclerotic walls of the ascending aorta cannot be preserved and wrapped as done for moderate dilation, for which conservative techniques are preferred.

In conclusion, stentless valve implantation in a dilated aorta seems to be possible in many situations, and the surgical approach to the aortic root must be individually tailored to each patient’s anatomy. We again thank Dr Siebenmann for his contribution to our understanding of this difficult problem.

References

1. Petracek M.R., Shuman T.A., Pirolo S.J., Tedder M., Ball S.K., Graves D. Use of Toronto stentless porcine valve in patients with aortic dilatation. Semin Thorac Cardiovasc Surg 1999;11:74-78.[Medline]
2. Siebenmann R.P. Implantation of the Toronto SPV stentless porcine bioprosthesis in dilated ascending aorta. Ann Thorac Surg 1997;64:1197-2000.[Abstract/Free Full Text]
3. Massetti M., Bruno P., Babatasi G., et al. Aortic root remodelling with the "cuff" technique for stentless valve implantation. Ann Thorac Surg 2001;71:1053-1055.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Massimo Massetti Gerard Babatasi Andre Khayat Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Massetti, M. Articles by Khayat, A. Search for Related Content PubMed Articles by Massetti, M. Articles by Khayat, A. Related Collections Great vessels Valve disease Related Article