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      Combined Replacement of Aortic Valve and Ascending Aorta—A 70-Year Evolution of Surgical Techniques

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          Abstract

          Simultaneous replacement of the ascending aorta and aortic valve has always been a challenging procedure. Introduction of composite conduits, through various ingenious procedures and their modifications, has changed the outlook of patients with aortic valve disease and ascending aorta pathology. In the past 70 years, progress of surgical techniques and prosthetic materials has allowed such patients to undergo radical procedures providing excellent early and long-term results in both young and elderly patients. This article aims to review the most important technical advances in the treatment of aortic valve disease and ascending aorta aneurysms recognizing the important contributions in this field.

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          Most cited references41

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          A technique for complete replacement of the ascending aorta.

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            Bentall Procedure: A Systematic Review and Meta-Analysis

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              Complete replacement of the ascending aorta with reimplantation of the coronary arteries: new surgical approach.

              Thirty patients had total replacement of the ascending aorta with reimplantation of the coronary arteries, 20 for a fusiform aneurysm of the ascending aorta and 10 because of a dissection of the ascending aorta, of which there were acute. All had associated aortic insufficiency. The technique consists of implantation, within the aneurysmal sac, of a Dacron prosthesis containing a Björk-Shiley aortic valve. The coronary orifices are anastomosed to the tubular Dacron prosthesis by means of a second smaller Dacron tube. The aneurysmal pouch is then closed over the entire appliance and a fistula between the aneurysmal sac and the right atrial appendage is created to drain oozing from the prosthesis. The operative mortality was 10% (three deaths) and the late mortality has been 14.8% (four deaths). The deaths, early and late, have been confined to the first 10 cases, during which time the technique was being developed. There has been no mortality among the last 20 patients. The 23 survivors followed for an average of 19 1/2 months (range 6 months to 5 1/2 years) are in NYHA Functional Class I (21) or II (two). The technical modifications utilized in this series have simplified the operation and permit the proposal of this technique for aneurysm involving the entire ascending aorta.
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                Author and article information

                Journal
                Aorta (Stamford)
                Aorta (Stamford)
                10.1055/s-00039245
                AORTA Journal
                Thieme Medical Publishers, Inc. (333 Seventh Avenue, 18th Floor, New York, NY 10001, USA )
                2325-4637
                June 2021
                11 October 2021
                1 October 2021
                : 9
                : 3
                : 118-123
                Affiliations
                [1 ]Division of Cardiac Surgery, Cardiothoracic Department, University Hospital, Udine, Italy
                Author notes
                Address for correspondence Uberto Bortolotti, MD Largo Traiano 23, 35036 Montegrotto Terme (PD)Italy uberto48@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-9184-6428
                http://orcid.org/0000-0002-1319-8146
                Article
                200034
                10.1055/s-0041-1729913
                8598315
                34634836
                1cc9e415-285e-413d-8880-0af446f16cab
                The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. ( https://creativecommons.org/licenses/by/4.0/ )

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 June 2020
                : 25 February 2021
                Funding
                Funding None.
                Categories
                Historical Perspective

                aorta,ascending aorta,ascending aorta replacement,aortic valve replacement

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