Short-term results of sleeve wrapping technique using remnant aortic wall in modified Bentall procedure_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MENG Maolong ¹ , WANG Yao ¹ , LU Pingfan ¹ , LI Huapeng ¹ , REN Rong ¹ , ZHANG Wen ¹ , CHEN Fengjie ¹ , ZHUANG Xianmian ¹ , WANG Xiang ¹ , LI Gang ¹ ,  GUO Hongwei ²

1. Department of Vascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, 518057, Guangdong, P. R. China;
2. Department of Vascular Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P. R. China;

Corresponding?author：

GUO Hongwei, Email: ghwdr@sina.com

Keywords：

Surgery; hemostasis; modified Bentall procedure

DOI：

10.7507/1007-4848.202204009

Video：

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Objective To evaluate the short-term results of sleeve wrapping technique using remnant aortic wall in modified Bentall procedure. Methods The patients undergoing modified Bentall procedure with the remnant aortic wall as a sleeve to cover the sewing area of composite valved graft and the aortic annulus for proximal hemostasis between March 2021 and March 2022 in Shenzhen Fuwai Hospital were enrolled. Short-term results were assessed by cardiopulmonary bypass time, aortic clamping time, mechanical ventilation time, ICU stay, postoperative hospital stay, effusion drainage on the first postoperative day, left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), and follow-up results. Results A total of 14 patients were collected, including 12 males and 2 females, with a mean age of 55.33±10.57 years. There was no postoperative or follow-up death. Cardiopulmonary bypass time was 147.90±21.29 min, aortic clamping time was 115.70±15.23 min, mechanical ventilation time was 19.42±8.98 h, ICU stay was 99.08±49.42 h, and postoperative hospital stay was 16.33±2.74 d. Thoracic drainage volume was 333.33±91.98 mL on the first postoperative day. Only 2 patients required blood transfusion (4.5 U and 2 U, respectively). During the follow-up of 6.17±3.69 months, there was no death, no aortic or valve-related complications. There was statistical difference in the LVEDD between preoperation and before discharge after surgery (P＜0.001), and between half a year after surgery and before discharge after surgery (P＜0.001). There was a little decrease of LVEF before discharge after surgery compared with preoperative LVEF, but there was no statistical difference (P=0.219). There was no statistical difference in the LVEF half a year after operation compared with that before operation (P=1.000). Conclusion Sleeve wrapping technique using remnant aortic wall in modified Bentall procedure has good short-term results. This modification may be a simple, effective way in controlling proximal bleeding.

Citation： MENG Maolong, WANG Yao, LU Pingfan, LI Huapeng, REN Rong, ZHANG Wen, CHEN Fengjie, ZHUANG Xianmian, WANG Xiang, LI Gang, GUO Hongwei. Short-term results of sleeve wrapping technique using remnant aortic wall in modified Bentall procedure. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(2): 283-287. doi: 10.7507/1007-4848.202204009 Copy

1.	Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4): 338-339.
2.	Cabrol C, Gandjbakhch I, Cham B. Aneurysms of the ascending aorta; total replacement with reimplantation of the coronary arteries (author's transl). Nouv Presse Med, 1978, 7(5): 363-365.
3.	Cabrol C, Pavie A, Gandjbakhch I, et al. Complete replacement of the ascending aorta with reimplantation of the coronary arteries: New surgical approach. J Thorac Cardiovasc Surg, 1981, 81(2): 309-315.
4.	李欣, 范瑞新, 張洪宇, 等. Cabrol手術治療Stanford A型主動脈夾層的療效評價. 中國胸心血管外科臨床雜志, 2019, 26(7): 670-673.
5.	Kouchoukos NT, Marshall WJ, Wedige-Stecher TA. Eleven-year experience with composite graft replacement of the ascending aorta and aortic valve. J Thorac Cardiovasc Surg, 1986, 92(4): 691-705.
6.	Kouchoukos NT. Aortic graft-valve (composite) replacement at 20 years: Wrap or no wrap? Shunt or no shunt? Ann Thorac Surg, 1989, 48(5): 615-616.
7.	Kouchoukos NT, Wareing TH, Murphy SF, et al. Sixteen-year experience with aortic root replacement. Results of 172 operations. Ann Surg, 1991, 214(3): 308-318.
8.	崔金帥, 晁文晗, 高秉仁, 等. 主動脈根部疾病手術選擇的研究進展. 中國胸心血管外科臨床雜志, 2019, 26(5): 504-508.
9.	Karangelis D, Tzertzemelis D, Demis AA, et al. Eighteen years of clinical experience with a modification of the Bentall button technique for total root replacement. J Thorac Dis, 2018, 10(12): 6733-6741.
10.	Khachatryan Z, Leontyev S, Magomedov K, et al. Management of aortic root in type A dissection: Bentall approach. J Card Surg, 2021, 36(5): 1779-1785.
11.	Di Eusanio M, Cefarelli M, Zingaro C, et al. Mini Bentall operation: Technical considerations. Indian J Thorac Cardiovasc Surg, 2019, 35(Suppl 2): 87-91.
12.	Hussain G, Ahmad N, Ahmad S, et al. New modification of modified bentall procedure (a single centre experience). Pak J Med Sci, 2015, 31(6): 1318-1321.
13.	Salve GG, Mavanoor SS, Rajanna V, et al. Double reinforcement of proximal anastomosis in Bentall procedure: A new technique. Indian J Thorac Cardiovasc Surg, 2013, 29(3): 184-187.
14.	Lee SI, Choi CH, Park KY, et al. "Wings of a butterfly" technique in modified Bentall's procedure. Thorac Cardiovasc Surg, 2022, 70(4): 339-340.

1. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 1968, 23(4): 338-339.
2. Cabrol C, Gandjbakhch I, Cham B. Aneurysms of the ascending aorta; total replacement with reimplantation of the coronary arteries (author's transl). Nouv Presse Med, 1978, 7(5): 363-365.
3. Cabrol C, Pavie A, Gandjbakhch I, et al. Complete replacement of the ascending aorta with reimplantation of the coronary arteries: New surgical approach. J Thorac Cardiovasc Surg, 1981, 81(2): 309-315.
4. 李欣, 范瑞新, 張洪宇, 等. Cabrol手術治療Stanford A型主動脈夾層的療效評價. 中國胸心血管外科臨床雜志, 2019, 26(7): 670-673.
5. Kouchoukos NT, Marshall WJ, Wedige-Stecher TA. Eleven-year experience with composite graft replacement of the ascending aorta and aortic valve. J Thorac Cardiovasc Surg, 1986, 92(4): 691-705.
6. Kouchoukos NT. Aortic graft-valve (composite) replacement at 20 years: Wrap or no wrap? Shunt or no shunt? Ann Thorac Surg, 1989, 48(5): 615-616.
7. Kouchoukos NT, Wareing TH, Murphy SF, et al. Sixteen-year experience with aortic root replacement. Results of 172 operations. Ann Surg, 1991, 214(3): 308-318.
8. 崔金帥, 晁文晗, 高秉仁, 等. 主動脈根部疾病手術選擇的研究進展. 中國胸心血管外科臨床雜志, 2019, 26(5): 504-508.
9. Karangelis D, Tzertzemelis D, Demis AA, et al. Eighteen years of clinical experience with a modification of the Bentall button technique for total root replacement. J Thorac Dis, 2018, 10(12): 6733-6741.
10. Khachatryan Z, Leontyev S, Magomedov K, et al. Management of aortic root in type A dissection: Bentall approach. J Card Surg, 2021, 36(5): 1779-1785.
11. Di Eusanio M, Cefarelli M, Zingaro C, et al. Mini Bentall operation: Technical considerations. Indian J Thorac Cardiovasc Surg, 2019, 35(Suppl 2): 87-91.
12. Hussain G, Ahmad N, Ahmad S, et al. New modification of modified bentall procedure (a single centre experience). Pak J Med Sci, 2015, 31(6): 1318-1321.
13. Salve GG, Mavanoor SS, Rajanna V, et al. Double reinforcement of proximal anastomosis in Bentall procedure: A new technique. Indian J Thorac Cardiovasc Surg, 2013, 29(3): 184-187.
14. Lee SI, Choi CH, Park KY, et al. "Wings of a butterfly" technique in modified Bentall's procedure. Thorac Cardiovasc Surg, 2022, 70(4): 339-340.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short-term results of sleeve wrapping technique using remnant aortic wall in modified Bentall procedure

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