Implante subvalvar do anel da prótese no tratamento cirúrgico dos aneurismas da aorta ascendente

a techinical modification of the bentall and debono operation for treatment of ascending aorta aneurysm is presented. the subvalvular insertion of the prosthesis sewing ring is accomplished, passing interrupted u sutures, consecutively in the sewing ring and in the native aortic valve annulus. as a result, direct reimplatation of the coronary arteries to the graft is simplified, particularly when the coronary ostia presents little or no cephalad displacement, as is usually the case in small aneurysms. in addition, it provides a more secure proximal anastomosis. fifteen patients were operated on by this technique. in all but one, the coronary ostia were reattached to the vascular prosthesis. there were two hospital deaths not related to the technique. the 13 survivors were followed from 72 days to 109 months. no dysfunction of the valvular prosthesis was observed at periodic clinical and ecocardiographic evaluations. however, two late deaths occurred: one, of unknown cause, after 6 months; the other, after 40 months, related to a new surgery for treatment of a dissecting thoracoabdominal aneurysm.