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eComment: Safety and effectiveness of partial aortic root remodeling

Monaldi Hospital, via L Bianchi, 80131 Naples, Italy

Modified partial aortic root remodeling in acute type A aortic dissection

The technique presented [1] is not really original since others (some cited, some others not cited by the present authors) have already presented very similar procedures. The technique is presented as a modification of the Yacoub procedure; however, it rather seems a modified maneuver of proximal stump reinforcement, where Dacron is used inside the sinus instead of Teflon and it is extended to the full height of the sinus. Every technical innovation is welcome in cardiac surgery as far as it adds to the safety and effectiveness of surgical correction of cardiovascular diseases. We have some concerns regarding the safety of this procedure, especially in terms of risk of valve leaflets distortion and, in case of coronary sinus repair also of ostial impingement. In fact the authors claimed that ‘problems developed in the coronary arteries’ in some patients, without specifying the mechanisms by which those problems occurred. Furthermore, the effectiveness of this procedure needs confirmation in the long-term follow-up, considering the risk of root dilatation, which is not lower than after traditional Yacoub procedure. Pseudoaneurysm could develop from the suture line fixing the patch to the sinus wall, especially proximally. Given the greater technical simplicity of the Bentall procedure, the author's implicit argument that inexpert surgeons are often involved in emergency surgery for type A dissection does not support preference of their technique.

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1. Komiya T, Tamura N, Sakaguchi G, Kobayashi T. Modified partial aortic root remodeling in acute type A aortic dissection. Interact CardioVasc Thorac Surg 2009;8:306–309.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Alessandro Della Corte Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Dialetto, G. Articles by Manduca, S. Search for Related Content PubMed PubMed Citation Articles by Dialetto, G. Articles by Manduca, S. Related Collections Related Article