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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): Augusto D’Onofrio Stefano Auriemma Paolo Magagna Nicola Abbiate Alessandro Fabbri Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by D’Onofrio, A. Articles by Fabbri, A. Search for Related Content PubMed PubMed Citation Articles by D’Onofrio, A. Articles by Fabbri, A. Related Collections Valve disease Related Article

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Correspondence

The Inclusion Technique Reduces Ischemia After Stentless Aortic Root Replacement

Division of Cardiac Surgery, San Bortolo Hospital, Viale Rodolfi 37, Vicenza 36100, Italy

(Email: adonofrio{at}hotmail.it; adonofrio{at}cardiochirurgiaitalia.it).

To the Editor:

We read with interest the article by Kincaid and coworkers [1].

The authors reported 13 patients (2.6%, from a total of 503 patients) with coronary artery insufficiency who required unplanned coronary artery bypass grafting (CABG) after aortic root replacement (ARR) with stentless bioprostheses using the total root technique. The finding that coronary complications may occur after such an operation is not surprising because this technique does not substantially differ from the "button Bentall" operation. In fact, the need for "bailout" CABG after the "button Bentall" procedure has been described [2].

From January 1993 to December 2006, 393 patients underwent ARR with the Edwards Lifesciences Prima Plus (Edwards Lifesciences, Irvine, CA) stentless aortic bioprosthesis implanted with the "mini-root" inclusion technique at our institution [3]. In these patients we did not experience any case of post-procedural myocardial ischemia requiring unplanned CABG. We believe that this is mainly due to the fact that during the mini-root inclusion technique, coronary ostia are not isolated but remain in their original native position. The patient’s coronary ostia are directly connected to the prosthesis after an appropriate trimming of the porcine coronary ostia (Fig 1). Thus, coronary artery kinking and bleeding seem to be very unlikely. Furthermore no reoperations for pseudoaneurysms or other complications affecting the aortic root have been performed until now. In conclusion, we believe that the mini-root inclusion technique, whenever feasible, represents a safe and effective alternative for ARR with stentless bioprostheses.

View larger version (73K): [in this window] [in a new window]   Fig 1. (A) The xenograft is placed into the native aortic root, and the porcine coronary ostium (arrow) has been properly trimmed before the anastomosis. (B) The porcine coronary ostium was anastomosed to the right coronary ostium of the patient (arrow).

	References

Top References

 

1. Kincaid EH, Cordell AR, Hammon JW, Adair SM, Kon ND. Coronary insufficiency after stentless aortic root replacement: risk factors and solutions Ann Thorac Surg 2007;83:964-968.[Abstract/Free Full Text]
2. Westaby S, Katsumata T, Vaccari G. Aortic root replacement with coronary button re-implantation: low risk and predictable outcome Eur J Cardiothorac Surg 2000;17:259-265.[Abstract/Free Full Text]
3. Auriemma S, D’Onofrio A, Brunelli M, et al. Long-term results of aortic valve replacement with Edwards Prima Plus stentless bioprosthesis: eleven years’ follow-up J Heart Valve Dis 2006;15(5):691-695.[Medline]

This article has been cited by other articles:

				E. H. Kincaid Reply Ann. Thorac. Surg., March 1, 2008; 85(3): 1144 - 1145. [Full Text] [PDF]

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): Augusto D’Onofrio Stefano Auriemma Paolo Magagna Nicola Abbiate Alessandro Fabbri Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by D’Onofrio, A. Articles by Fabbri, A. Search for Related Content PubMed PubMed Citation Articles by D’Onofrio, A. Articles by Fabbri, A. Related Collections Valve disease Related Article