Which patients should have VSRRR?
While the advantages of VSRRR are evident, it is a more complex
operation requiring a longer cardiopulmonary bypass and ischaemic times(22). Therefore, patients should be carefully selected
for a successful outcome. It is critical to consider the presentation of
the patient in the decision-making. Aubin et.al used the reimplantation
procedure preferentially in patients with TAAAD, unless the patient is
critically ill (23).In general, if a root replacement
be indicated and a patient is haemodynamically unstable patients or has
malperfusion, VSRR should not be performed. We also consider the
patient’s age and co-morbidities, while there is no age cut-off, the
mean age in our series was 46 years of age and the mean age in other
series was not much different (24, 25) .
Transesophageal echocardiography should be carefully studied in the
operating room for valve morphology, AI degree, AI jet direction, cusp
prolapse, annular diameter together with concomitant valvular
pathologies(26).