Efficacy of a sutureless aortic valve-reoperative alternative to a composite graft replacement

Findings in the present case underscore the potential of sutureless aortic valve utilization in patients with prior prosthetic root replacement, thereby obviating the need for high-risk procedures such as replacing a prosthetic root or reimplanting a coronary artery. A 75-year-old male who had undergone a Bio-Bentall operation with a bioprosthetic Trifecta valve for aortic regurgitation and annuloaortic ectasia eight years prior presented with symptoms of heart failure, notably dyspnoea, attributed to prosthetic valve dysfunction. Although a transcatheter aortic valve implant is often recommended, it was deemed unsuitable in this case due to a history of type B aortic dissection. Aortic valve replacement utilizing a sutureless Perceval valve with a Trifecta cuff as the valve ring was successfully performed through a repeat median sternotomy, which enabled aortic valve replacement via a higher than usual aortotomy with minimal adhesion dissection. Despite the inherent risks associated with a reoperation post-Bentall surgery, the duration of the procedure was notably short, with only 85 minutes required for cardiopulmonary bypass and 51 minutes for aortic clamping, resulting in an overall operating time of 198 minutes, thus highlighting the minimally invasive and safe nature of this approach.