Guest Editor Series: Mastering Aortic Root Surgery—Learning From Top Surgeons

In the latest CTSNet Guest Editor Series, Mastering Aortic Root Surgery—Learning From Top Surgeons, cardiac surgeon and CTSNet Senior Editor Dr. Lorena Montes invited top cardiac surgeons from around the world to contribute clinical videos on various aortic root surgery techniques, such as the David procedure for aortic regurgitation, the Ross procedure for aortic stenosis, and Bio Bentall and aortic root enlargement.

This series features videos from five global cardiac surgeons, which can be found at the bottom of this page as they are released from 14–21 October 2024, concluding with a panel discussion recorded at EACTS 2024 to be released on 21 October 2024.

In this panel discussion, Dr. Montes and top cardiac surgeons in aortic root management discuss the interesting cases presented in this Guest Editor Series, the intricacies of different procedures, tips and tricks, controversies in case management, and share their expert opinions

View Panel Discussion

Dear CTSNet Reader, 

Aortic root management is generally complex and often presents situations that require different alternatives. At this moment, it is considered a hot topic in cardiac surgery with significant technical evolution and a variety of procedures to choose from to determine surgeries best suited to each patient and specific pathologies, thereby improving long-term outcomes.

The aortic root can have different diseases and etiologies that often indicate which pathway to follow and the best surgery to perform. The field has evolved toward benefits in terms of survival, freedom from reintervention, anticoagulation, and endocarditis. 

In this video series, leaders in the cardiothoracic field from all over the world guide viewers through different techniques involved in aortic root procedures. It covers topics such as the David procedure for aortic regurgitation, the Ross procedure for aortic stenosis, and Bio Bentall and aortic root enlargement, along with interesting clinical cases, step-by-step instructions, and expert opinions and discussion. 

This series serves as an essential resource for experienced surgeons and those in training, by enhancing understanding of critical surgical decision-making and diverse techniques.

Dr. Maral Ouzounian from the Peter Munk Cardiac Center in Toronto, Canada, performed a Bio Bentall procedure using a valvulated biological composite graft in an 82-year-old patient with aortic regurgitation, showing the gold standard of management of root dilation. 

Dr. Alberto Forteza from Hospital Puerta de Hierro in Madrid, Spain, executed a David procedure in a young Marfan patient, demonstrating the step-by-step process of valve sparing root replacement.

Dr. Gustavo Prieto from Fundación Cardiovascular de Colombia in Bucaramanga, Colombia, demonstrated an alternative to homografts in a Ross procedure that can be particularly useful in places where homografts are not readily available.

Dr. Mazyar Kanani from James Cook University Hospital in Middlesborough, England, presented an innovative approach to aortic root replacement in which the aorta is opened but not resected, and the coronary buttons are not harvested. 

Dr. Bo Yang from the University of Michigan, USA, guided viewers through his novel technique for root enlargement in a patient with a small aortic root, significantly increasing the size of the prosthesis to a 29. 

This series concludes with a panel discussion featuring the authors of the videos, joined by experts including Dr. Ismail El-Hamamsy from Mount Sinai, New York, USA, and Dr. Juan Pablo Umaña from Cleveland Clinic, USA. The panel discusses the techniques featured in the videos, shares tips and tricks used in aortic root management, and address questions and controversies in the field.

We hope this series is valuable to the CTSNet audience and that it has a positive impact on the management of aortic root pathology across the world. 

Lorena Montes, MD

Contributor Videos

1. Aortic Root Replacement With a BioBentall by Maral Ouzounian

2. Aortic Valve Reimplantation in a Marfan Syndrome Patient by Alberto Forteza Gil

3. Porcine Xenograft as an Alternative to Homografts in the Ross Procedure: The Colombian Solution by Gustavo Prieto

4. The Chrysalis Technique : A Unique New Way to Perform an Aortic Root Replacement by Mazyar Kanani

5. Updates on Y-Incision Aortic Annular Enlargement by Bo Yang

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