Replacement of a prosthetic valve after the Bentall procedure

Patients undergoing a composite graft replacement of the aortic root with reimplantation of the coronary ostia (Bentall procedure) are at risk for late prosthetic heart valve dysfunction: approximately 10% of the patients are expected to experience this complication at 10 years. Therefore, replacement of the prosthetic valve is indicated. This procedure involves technical problems related to the manipulation and the reconstruction of the composite graft without distortion of the coronary arteries. We describe a simple surgical approach to treat these particular patients.