Bentall or VSRR in patients with TAAAD?
When deciding if the aortic valve replacement is warranted as well as
the appropriate type of prosthesis, there are several clinical variables
which should be considered. The decision should be a shared process
between the surgeon and the patient, and it is unfortunate that the
emergency nature of the disease doesn’t allow for an informative heart
team discussion (18). Mechanical prostheses are
associated with 10% risk of major haemorrhage secondary to
anticoagulation at 10 years, freedom from valve dysfunction was 91% at
with a modest 80% freedom from valve dysfunction at 10 years;
furthermore, the long –term survival of young patients following
mechanical valve replacement was poor in comparison with a healthy
cohort of contemporaries(19). Biological valve
replacement comes with a lower risk of thromboembolism and major
bleeding; however, the freedom from reintervention or death is as high
as 40% at 10 years(20). It is therefore reasonable to
conclude that prosthetic valve replacement in itself is a disease that
carries the risk of complications and death. In aortic root disease, the
prosthetic valve component is a major drawback and should be avoided if
possible, particularly in the young. In aortic root replacement, Salsami
et.al meta-analysis reported a lower operative mortality, better 5-year
survival, lower thromboembolic events in favour for VSRR in comparison
with Bentall; however and increase in reoperation rate was noted (OR1.3,
95% CI 0.72-2.33)(21).