The double sewing ring technique: a not so easy reoperation!

Abstract

This recently published article by Albertini et al. [1] beautifully depicts the modified Bentall operation: the double sewing ring technique. We have made use of a similar technique for years, but unfortunately it does not mean that it renders the use of bioprosthetic valves any easier. We had two patients with prosthetic valve malfunction, which necessitated valve replacement. Surgery proved problematic, however, because even utilizing a Valsalva tube did not reduce the probability of the dehiscence of the coronary ostia or the whole graft. The present manuscript states that neither patient required reoperation, but we are inclined to believe that the patients in question will refer to the hospital in the near future for the same problem. We employ this technique for patients with small aortic annuluses or for patients who need root enlargement because, as the manuscript itself attests, not only does this independent selection of graft and valve size minimize the chance of valve-to-graft mismatch but also the use of smaller size sutures decreases the probability of bleeding. In conclusion, although this technique is suitable for small or calcified annuluses, we fear that an extensive use of this technique with bioprosthetic valves could beget trouble. Consequently, it is advisable that this technique not be recommended for the time being until the patients’ followup is complete. Reference