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Concomitant Bentall operation plus aortic arch replacement surgery
Han-Chin Tsai1, I-Ming Chen, Yuan-Chen Hsieh
1Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Insights
Concomitant Bentall operation plus aortic arch replacement (CoBAAR) is a complex surgery for extensive aortic disease. Despite challenges, this one-stage procedure offers satisfactory outcomes, potentially reducing reoperation needs.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- The Bentall operation addresses aortic root issues, but extensive lesions require concomitant Bentall operation plus aortic arch replacement (CoBAAR).
- CoBAAR is technically demanding, involving complex cardiopulmonary procedures and prolonged bypass times, leading to high mortality and morbidity.
- Performing CoBAAR as a single stage can prevent reoperations due to residual aneurysm progression.
Purpose of the Study:
- To evaluate the feasibility and outcomes of concomitant Bentall operation plus aortic arch replacement (CoBAAR).
- To assess the safety and efficacy of this one-stage surgical approach for extensive aortic dissections and aneurysms.
Main Methods:
- A retrospective review of nine patients who underwent CoBAAR between January 2005 and May 2010.
- Patients had either Stanford type A aortic dissection or ascending aortic and arch aneurysm.
- Procedures included Bentall operation with hemiarch or total arch replacement, with elephant trunk insertion in extensive cases.
Main Results:
- In-hospital mortality was 11.1% (one patient).
- Morbidity included stroke (2 patients), spinal cord injury (1 patient), prolonged ventilation (5 patients), and temporary dialysis (3 patients).
- Eight out of nine patients survived the procedure.
Conclusions:
- CoBAAR is a complex but achievable surgical technique for extensive ascending aortic dissection or aneurysm.
- The procedure can yield satisfactory results despite its demanding nature and associated risks.
Background:
The Bentall operation is recommended for thoracic aortic dissection or aneurysm involving the aortic root. However, if the lesion extends to the aortic arch, concomitant Bentall operation plus aortic arch replacement (CoBAAR) surgery is required. CoBAAR is challenging because of its complex cardiopulmonary procedure, prolonged cardiopulmonary bypass time, and demanding operative techniques. Therefore, surgical mortality and morbidity rates for CoBAAR are very high. However, the Bentall operation performed as a single procedure may lead to reoperation if the residual aneurysm progresses. Therefore, CoBAAR as a one-stage surgery can lower the need for reoperation and possible further complications.
Methods:
Nine patients received CoBAAR during January 2005 to May 2010. Six patients were diagnosed with Sanford type A aortic dissection and three with nondissecting ascending aortic and arch aneurysm. Four patients received a Bentall operation plus hemiarch replacement. The others received a Bentall operation plus total arch replacement along with elephant trunk because of extensive lesions.
Results:
The in-hospital mortality was 11.1% (1 patient with total arch replacement). Morbidity included stroke (2 patients), spinal cord injury (1 patient), mechanical ventilation for more than 72 hours (5 patients), and temporary renal dialysis (3 patients). Eight patients survived.
Conclusion:
CoBAAR is a demanding operative technique requiring complex cardiopulmonary bypass. However, surgeons can perform this procedure on extensive ascending aortic dissection or aneurysm patients, achieving satisfactory results.
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