Bentall vs VSRR
It has been a few decades since the original inception of the Bentall
method11, undergoing many revolutions in surgical
techniques and approaches12; however, this procedure
still presents with disadvantages and issues of potential
complications.13 Furthermore, under certain
indications the Bentall is not always the optimum interventional
approach for a root replacement, in some such cases a valve-sparing root
replacement (VSRR) can be considered.14 Following the
use of a mechanical conduit for root replacement, there is the need of
lifelong anticoagulation medication; With the use of a biological
conduit there is the higher risk of re-operation, an even greater
negative impact on younger patients.13, 14 The VSRR
procedure allows the native aortic valve to be preserved, avoiding some
of the cons of a complete root replacement, allowing more favorable
haemodynamic outcomes.14 In the recent meta-analysis
of 9 studies comprising 706 patients treated for ATAAD, VSRR was
systematically reviewed as an option for
intervention.15 Junlin Wu et al. were able to conclude
that the use of VSRR in ATAAD provided highly favorable outcomes in the
early and late period in comparison to the patients undergoing Bentall
procedure. It should be noted that the authors had clearly stated that
these amazing results for VSRR, are only achieved by the carefully
considered patient selection process for the
procedure.15