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Question:
Is the Bentall procedure right for me?
I have an aortic root of 5.9 cms with a slightly insufficient aortic valve. I am 36 years old and with no symptoms, yet it was observed during periodic revision. I consulted 3 surgeons in my country and 2 mentioned I needed a Bentall de Bonno procedure, and one said a Davis or Davids procedure. I don't remember. Is the Bentall de Bonno procedure right for me?
submitted by Gerardo from Los Cabos, Mexico, on 10/28/09
Answer:
by Texas Heart Institute surgeon, James J. Livesay, MD
Surgery is highly recommended because of the size of the aneurysm (over 5.0 cm) and risk of rupture or death. The Bentall procedure involves replacing the aorta with a Dacron graft, the aortic valve with an attached prosthetic valve, and reconnecting the coronary arteries into the side of the graft. This is the standard approach to this problem and it works well for most patients.
The David procedure involves replacing the aneurysm with a Dacron graft, reimplanting the coronary arteries, but differs in that it preserves the patient's own aortic valve implanting this into the Dacron graft. The David procedure has some advantages in younger patients in that it preserves your own aortic valve and voids the need for lifelong anticoagulation with Coumadin (or Warfarin), which is required in patients with mechanical heart valves. The principal limitation of the David procedure is that it often involves repair of the dilated aortic valve and that the longevity of the valve repair is uncertain, and therefore, the patient may need reoperation in 5-10 years or more to replace the aortic valve.
Nevertheless, the David procedure is currently favored by many surgeons for younger patients with aortic root aneurysms.
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Updated October 2009
