Simple Conversion of a Mechanical Bentall to a Biological Bentall

A patient with Marfan syndrome and a composite aortic root with mechanical valve placed 35 years ago presented with cerebral amyloid angiopathy complicated by recurrent intracranial hemorrhage. To avoid systemic anticoagulation with warfarin, he was converted to a biological Bentall by removal of the mechanical valve leaflets, but leaving the valve housing in place. Prevention of embolization of leaflets was achieved by placing a Foley catheter through the valve into the left ventricular outflow tract and inflating the balloon. The intraoperative course and early postoperative course were unremarkable. The patient was discharged on postoperative day five and has done well without anticoagulation. In follow-up of this and five other patients, there have been no recurrent cerebral bleeds and no thromboembolism from the old mechanical valve housing or the new bioprosthesis. In conclusion, a mechanical Bentall can be converted to a biological Bentall by simply removing the mechanical valve leaflets and placing a bioprosthesis above the housing of the original mechanical valve.

Reference

Vricella LA, Cameron DE. Facile conversion from mechanical to bioprosthetic composite aortic root replacement. J Thorac Cardiovasc Surg. 2007 Feb;133(2):565-567.

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