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Ann Thorac Surg 2003;75:640
© 2003 The Society of Thoracic Surgeons

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Correspondence

Open technique or Bentall/de Bono technique?

Cardiac Surgery Department, Ospedale San Giovanni Battista, C.so Bramante 88 Torino, Italia

e-mail: f_patane{at}hotmail.com

To the Editor:

The article by Panos and associates [1] was very interesting. In any case, we would like to venture some remarks. The employment of two techniques (open technique and Bentall/de Bono) cannot be compared without distinguishing between acute dissection (emergency) and chronic ascending aortic aneurysm because the anatomy is very different.

When the ascending aortic aneurysm is chronic with anulo-aortic ectasia (Marfan’s Syndrome), the most important step is to relocate the coronary ostia to avoid stress in the first segment of the coronary arteries and possible pseudo-aneurysm due to bleeding. In these patients, moving the coronary ostia is relatively safe. In patients with acute dissection (emergency), opening the aorta and moving coronary ostia are very dangerous because of the aortic dissection and dissected tissues. However, because anulo-aortic ectasia is absent, relocation of the coronary ostia is not necessary.

To avoid pseudo-aneurysms at the anastomotic sites, we use the following classic technique. The proximal end of the valved composite graft is anchored with interrupted Ticron 2/0 mattress sutures to facilitate using a prosthesis similar to the size of the native valve. We use continuous 4/0 polypropylene sutures between the aortic annulus and the annulus ofthe valved graft to prevent bleeding and formation of pseudo-aneurysms.

We prefer the Bentall/de Bono technique for acute dissections, and attach the coronary ostia with a 5–6/0 polypropylene continuous suture. With chronic aneurysms, we use two strips of pericardium around the coronary ostia suture and an aortic wall strip on the distal anastomosis to the native aorta. Thus, the technique must be selected depending upon the anatomy. Two different techniques are needed for two different types of aneurysms.

References

1. Panos A., et al. Influence of technique of coronary artery implantation on long-term results in composite aortic root replacement. Ann Thorac Surg 2001;72:1497-1501.[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 Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Isaac Gielchinsky Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gielchinsky, I. Search for Related Content PubMed PubMed Citation Articles by Gielchinsky, I. Related Collections Great vessels