Which patients should have VSRRR?
While the advantages of VSRRR are evident, it is a more complex operation requiring a longer cardiopulmonary bypass and ischaemic times(22). Therefore, patients should be carefully selected for a successful outcome. It is critical to consider the presentation of the patient in the decision-making. Aubin et.al used the reimplantation procedure preferentially in patients with TAAAD, unless the patient is critically ill (23).In general, if a root replacement be indicated and a patient is haemodynamically unstable patients or has malperfusion, VSRR should not be performed. We also consider the patient’s age and co-morbidities, while there is no age cut-off, the mean age in our series was 46 years of age and the mean age in other series was not much different (24, 25) .
Transesophageal echocardiography should be carefully studied in the operating room for valve morphology, AI degree, AI jet direction, cusp prolapse, annular diameter together with concomitant valvular pathologies(26).