{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T18:46:26Z","timestamp":1767897986009,"version":"3.49.0"},"reference-count":5,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T00:00:00Z","timestamp":1763769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>We report a case of simplified surgical conversion from a prior mechanical composite valved conduit to a bioprosthetic aortic valve using a leaflet fracture technique. A 69-year-old man presented with progressive heart failure 7 years after aortic root replacement for bicuspid aortic stenosis and root aneurysm. Imaging revealed severe prosthetic valve stenosis and suspected pannus formation. Given significant comorbidities, a simplified approach was chosen to avoid full root re-replacement. Following redo sternotomy and graft incision, the mechanical valve leaflets were fractured and removed. A Foley balloon inserted into the left ventricular outflow tract prevented leaflet embolization. Pannus excision revealed a hypertrophic subvalvular septum, prompting a septal myectomy. A 23-mm bioprosthetic valve was implanted above the retained mechanical housing using interrupted mattress sutures. The patient\u2019s postoperative course was uneventful, and echocardiography confirmed good valve function. This case highlights the utility of leaflet fracture as a safe and efficient option in high-risk reoperative settings and underscores the added benefit of direct subvalvular visualization for detecting underlying anatomic contributors to prosthetic dysfunction not detected preoperatively.<\/jats:p>","DOI":"10.1093\/icvts\/ivaf277","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T13:07:08Z","timestamp":1763644028000},"source":"Crossref","is-referenced-by-count":0,"title":["Simplified Surgical Conversion of Mechanical to Bioprosthetic Bentall With Leaflet Fracture Technique"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5530-5923","authenticated-orcid":false,"given":"Yasuhiko","family":"Kawaguchi","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, Waterloo Regional Health Network , Kitchener, Ontario, N2M 1B2,","place":["Canada"]},{"name":"Division of Cardiac Surgery, London Health Science Centre, Western University , London, Ontario, N6A 5A5,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Higgins","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Waterloo Regional Health Network , Kitchener, Ontario, N2M 1B2,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kassem","family":"Ashe","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Waterloo Regional Health Network , Kitchener, Ontario, N2M 1B2,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary","family":"Salasidis","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Waterloo Regional Health Network , Kitchener, Ontario, N2M 1B2,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,22]]},"reference":[{"key":"2026010808573822300_ivaf277-B1","doi-asserted-by":"crossref","first-page":"4043","DOI":"10.21037\/jtd-23-1629","article-title":"Reoperative aortic root surgery: single-center long-term outcomes and literature review","volume":"16","author":"Murana","year":"2024","journal-title":"J Thorac Dis"},{"key":"2026010808573822300_ivaf277-B2","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/S0022-5223(03)00702-5","article-title":"Obstruction of St Jude medical valves in the aortic position: histology and immunohistochemistry of pannus","volume":"126","author":"Teshima","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026010808573822300_ivaf277-B3","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.jtcvs.2006.10.024","article-title":"Facile conversion from mechanical to bioprosthetic composite aortic root replacement","volume":"133","author":"Vricella","year":"2007","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2026010808573822300_ivaf277-B4","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/S0003-4975(96)01391-4","article-title":"Obstruction of mechanical mitral prostheses: analysis of pathologic findings","volume":"63","author":"Vitale","year":"1997","journal-title":"Ann Thorac Surg"},{"key":"2026010808573822300_ivaf277-B5","first-page":"1","article-title":"First successful transcatheter valve-in-valve implantation into a failed mechanical prosthetic aortic valve facilitated by fracturing of the leaflets: a case report","volume":"5","author":"Butter","year":"2021","journal-title":"Eur Heart J Case Rep"}],"container-title":["Interdisciplinary CardioVascular and Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/icvts\/advance-article-pdf\/doi\/10.1093\/icvts\/ivaf277\/65482434\/ivaf277.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/12\/ivaf277\/65482434\/ivaf277.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/icvts\/article-pdf\/40\/12\/ivaf277\/65482434\/ivaf277.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T13:57:44Z","timestamp":1767880664000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/icvts\/article\/doi\/10.1093\/icvts\/ivaf277\/8340417"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,22]]},"references-count":5,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,12,1]]}},"URL":"https:\/\/doi.org\/10.1093\/icvts\/ivaf277","relation":{},"ISSN":["2753-670X"],"issn-type":[{"value":"2753-670X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,11,22]]},"article-number":"ivaf277"}}