Evaluation of coronary heights after Bio-Bentall using Piehler technique

The valve-in-valve procedure is an alternative to the redo surgery for structural valve deterioration following the Bio-Bentall. However, the risk of coronary obstruction and the feasibility of this approach remain unclear. Using computed tomography, we compared the aortic root geometry of 14 consecutive patients (13 true aortic aneurysms) with Bio-Bentall between April 2011 and April 2024 preoperatively and postoperatively. The Piehler technique was used in all coronary artery reconstructions. During the follow-up period, no reconstructive coronary events or valve-related reoperations were observed. The coronary height was 17.7 ± 5.6 mm preoperatively versus 18.8 ± 4.4 mm postoperatively for the left coronary artery (P =  0.49) and 15.4 ± 9.6 mm preoperatively versus 22.6 ± 7.4 mm postoperatively for the right coronary artery (P <  0.01). No patients at risk of coronary obstruction associated with valve-in-valve were identified. One case of severe aortic graft kinking due to excessive graft length, which could contraindicate the valve-in-valve procedure, was observed. Our findings suggested that the Piehler technique may facilitate future valve-in-valve implantation after Bio-Bentall because it allows for a higher-positioned orifice of the reconstructive coronary artery.