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).