Root Replacement with Biological Valved Conduits

  • Paolo Berretta
  • Marco Di Eusanio


In 1968, Bentall and De Bono introduced the surgical technique involving composite aortic valve and root replacement with reimplantation of the coronary arteries for treatment of thoracic aortic aneurysms [1]. Since its introduction, Bentall procedure has proven to be a safe and effective technique [2–4], and has been considered the gold standard in the surgical treatment of combined aortic valve and root pathologies. As initially described by Bentall and De Bono, it involved the use of a composite mechanical valved conduit. However, the use of biological aortic valve prostheses has increased noticeably over the last years [5]. This trend may be due to the raising prevalence of aortic valve diseases in the elderly population [6], the growing data proving excellent long-term durability of latest aortic prostheses [7, 8], the need for long-term anticoagulation for mechanical valves [6, 9] and the development of minimally invasive transcatheter valve-in-valve techniques [10]. Together, these data have triggered the development of alternative biological root substitutes and techniques for aortic root replacement such as biological hand-sewn composite grafts, xenograft aortic bioprosthetic root and total biological valved conduit. Compared to mechanical composite grafts, these biological valved conduits do not require lifelong oral anticoagulation and are subsequently associated with a lower thromboembolic/haemorragic risk.


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cardiac Surgery UnitOspedali RiunitiAnconaItaly

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