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• W4255517967 abstract "We appreciate the comments by Dr Frank A. Baciewicz on our article, “The Treatment of Recurrent Aortic Prosthetic Detachment with Modified Bentall Procedure: Results of Two Cases.” His respectable clinical experiences briefly describe a similar technique with a bioprosthesis in patients with endocarditis or requirement of aortic root replacement and its advantages. Prosthetic detachment after aortic valve replacement is one of the most frequent complications requiring reoperation.1De Cicco G. Lorusso R. Colli A. Nicolini F. Fragnito C. Grimaldi T. et al.Aortic valve periprosthetic leakage: anatomic observations and surgical results.Ann Thorac Surg. 2005; 79: 1480-1485Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar Many factors, including endocarditis, aortitis, anatomic characteristics, and surgical techniques, are thought to predispose a patient to this complication. However, the intrinsic anatomic factor is considered critical for an adverse event of this kind. The aortic annulus between the middle portion of the right coronary sinus and the middle portion of the noncoronary sinus corresponds to the area above the membranous part of the interventricular septum and the right trigone of the cardiac skeleton. This embryologic origin of the aortic annulus may be a reason for its intrinsic weakness. The base of the noncoronary leaflet does not appear to be embedded in the ventricular muscle and seems to be higher in the aortic root plane.2Thubrikar M. Nolan S.P. Bosher L.P. The cyclic changes and structure of the base of the aortic valve.Am Heart J. 1980; 99: 217-224Abstract Full Text PDF PubMed Scopus (67) Google Scholar However, the lack of muscular tissues presumes that this sector has hypodynamic properties, transforming it into a point of anchorage because of the greater dynamic energy developed by the other 2 bases. In addition, the mechanical changes start from the lowest point of each sinus of Valsalva during the cardiac cycle.3Lansac E. Lim K.H. Shomura Y. Dynamic balance of the aortomitral junction.J Thorac Cardiovasc Surg. 2002; 123: 911-917Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar Different dynamic characteristics cause the least expansion of this weak sector. The cooperation of the anatomic, mechanical, and pathologic factors may adversely increase to put stress on the base of the noncoronary leaflet, transforming it into a major site of prosthetic detachment: the dissection of the intrinsic weak annulus into the left ventricular outflow tract and a major flail-like rocking motion of the prosthesis. Taking into consideration the reconstruction with a valved conduit is helpful because the rigid prosthetic valve does not apply direct pressure to the aortic annulus and the flexible tubular prosthesis may cushion the stress. This modified translocated Bentall technique provides better flexibility and elasticity of the aortic annulus than the standard Bentall procedure.4Zhang C. Ni Y.M. Shi L.P. Jin T. The treatment of recurrent aortic prosthetic detachment with modified Bentall procedure: results of two cases.J Thorac Cardiovasc Surg. 2009; 138: 770-771Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar The technique also has the advantage of being more hemostatic, because it is easier to place a suture into the cuff of the conduit rather than placing the rigid aortic valve prosthesis on the native annulus. Bioprosthesis of a valved conduit is the better choice of reoperation for aortic prosthetic detachment caused by endocarditis. Moreover, the modified Bentall procedure has often been used to prevent valve detachment in prosthetic detachment caused by aortitis.5Okada K. Eishi K. Takamoto S. Ando M. Kosakai Y. Nakano K. et al.Surgical management of Behçet's aortitis: a report of eight patients.Ann Thorac Surg. 1997; 64: 116-119Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar Thoracic and cardiovascular surgeons may choose to use this technique. Treatment of recurrent aortic prosthetic detachment with modified Bentall procedureThe Journal of Thoracic and Cardiovascular SurgeryVol. 139Issue 3PreviewTo the Editor: Full-Text PDF" @default.
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• W4255517967 date "2010-03-01" @default.
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• W4255517967 title "Reply to the Editor" @default.
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