p.73 抽出テキスト
Otherwise, composite replacement of the aortic root and valve with the Bentall procedure is indicated. Pre-operative evaluation890 and initial follow-up of patients is defined in Figure 25. Patients with a bioprosthetic valve should be monitored by TTE annually. However, in patients with mechanical prosthesis or native aortic valve, clinical evaluation and TTE should be performed as soon as possible if new heart symptoms develop.969 SAPT with low- dose aspirin (75–100 mg per day) should be considered for the first 3 months after conservative aortic valve surgery if there are no indications for OAC. Lifelong OAC with a VKA is recommended for all patients with a Bentall mechanical prosthesis.970,971 However, in patients with no baseline indications for OAC, low-dose aspirin (75– 100 mg/day) or OAC using a VKA should be considered for the first 3 months after Bentall surgery with a bioprosthesis.972,973 TTE and TOE Aortic valve assessment CCT or CMR Annulus/root/ ascending aorta assessment Supracommisural tubular graft Aortic valve sparing Annuloplasty Bentall procedure Pre-surgery STJ dilatation (Ia) STJ and aortic root dilatation (Ib) Annulus dilatation (Ic) Aortic valve disease TTE Immediate cardiac complications (i.e. pericardial effusion...) CCT or CMR Rule out aortic complications Before discharge 1 month From 1 year TTE Aortic valve function and gradients Aortic root and proximal ascending aorta assessment TTE Aortic valve function and gradients Aortic root and proximal ascending aorta assessment Mechanical prosthesis or native valve: Bioprosthesis: TTE/year CCT or CMR Evaluation of aortic disease progression and rule out complications Aorta totally repaired: Follow-up at 2 years and then every 5 years link with aneurysm follow-up algorithm TTE based on gradients, symptoms or residual AR Aorta not fully repaired: Figure 25 Peri-operative algorithm for the management of patients with surgically treated aortic root and ascending aortic aneurysm. AR, aortic regurgitation; CCT, cardiovascular computed tomography; CMR, cardiovascular magnetic resonance; STJ, sinotubular junction; TOE, transoesophageal echocardiography; TTE, transthoracic echocardiography. Downloaded from academic.oup.com/eurheartj/article/45/36/3538/7738955 by guest on 07 October 2026