Modified Bentall operation: the double sewing ring technique

The Bentall-DeBono operation is the technique of choice for aortic root replacement. As more patients do not accept or have contraindications to lifelong anticoagulation, the biological Bentall operation is a good option for these patients, even though complex reoperations would then be required for bioprosthesis degeneration. We studied a modified technique to simplify the reoperations in patients undergoing biological Bentall procedure. A bioprosthetic valved conduit was obtained creating two separate sewing rings at different levels of the vascular graft. One ring was used to sew the bioprosthesis on the vascular graft. The second ring was used to fix the vascular graft on the native aortic annulus. In case of reoperation, the bioprosthesis could be removed cutting only the suture on the first ring. Then the same ring could be used to fix the new prosthesis. Since 2006, we have performed 12 biological Bentall operations with our modification. The mean age was 63.2 years (range 43-77 years), the mean cardiopulmonary time was 79 ± 12 min and the mean aortic cross-clamping time was 68 ± 10 min. We had no in-hospital mortality; the postoperative period was uneventful in all patients. In our experience this modification seems to be simple and reproducible, without increasing the operative risk and postoperative morbidity. © 2007 European Association for Cardio-Thoracic Surgery.