الفهرس 
ANATOMICAL BACKGROUNDOnly 14 pages are availabe for public view
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Abstract
The modified Bentall – De Bono procedure is considered the standard approach for the repair of aortic root aneurysm, ascending aortic aneurysm or a type A aortic dissection when accompanied by an incompetent, irreparable aortic valve.
However, the modified bentall procedure also exposes the patient to the problems associated with artificial valves. Mechanical valves, while long lasting, require life-long anticoagulation. Biological valves, while not requiring anticoagulation, expose the patient to the potential need for re-operation in 10–15 years which, in the case of a re-do modified bentall, is a major and relatively risky operation, the observation that in at least half of the patients the native valve cusps are undamaged led to the development of valve sparing aortic root reconstruction techniques.
Operations that replace the aortic root while preserving the valve have been developed by pioneers as Magdi Yacoub (remodelling procedure used since 1979) and Tirone David (reimplantation procedure performed since 1988) in an effort to improve quality of life for many patients.
The native aortic valve should be preserved whenever possible because a perfect prosthetic aortic valve is yet to be developed. The principal determinant of successful aortic valve-sparing operations is the quality of the aortic valve leaflets. Preoperative transesophageal echocardiography can often determine the number and the quality of the aortic valve leaflets. Patients with aortic root diameter in excess to 60 mm and gross aortic insufficiency frequently have damaged leaflets, and composite replacement of the aortic valve and ascending aorta is often necessary. The final decision, however, can only be made intraoperatively after careful inspection of the aortic valve leaflets.
The valve preserving techniques (remodeling/reimplantation) have gained more interest the past years in type A aortic dissection treatment along with their development in elective cases.
Our study was carried on a total number of 54 patients. The patients were divided into two groups. Group I consisted of 27 patients who underwent aortic root replacement using valve sparing Tirone David reimplantation technique. Group II consisted of 27 patients who underwent aortic root replacement using valve non sparing modified Bentall technique, data from the 54 patients were analyzed.
The aim of this study was to compare the early and short term results between valve sparing (reimplantation group) and valve non sparing (composite group) in aortic root replacement.
Absence of difference between the 2 groups concerning the preoperative risk factors made the results dependant mainly on the effects of presence or absence of aortic valve sparing.