Aortic valve replacement in Behcet's disease: surgical modification to prevent valve detachment.

Aortic valve replacement (AVR) for aortic regurgitation due to Behcet's disease is often complicated with valve detachment. In our institute, between 1981 and 2006, five consecutive patients with aortic regurgitation secondary to Behcet's disease underwent valve detachment after initial surgery. A novel modification of AVR termed 'subannular ring reinforcement technique' was introduced to prevent valve detachment. We performed AVR with this new manoeuvre in three patients. No prosthetic valve detachment was noted after a mean period of 3+/-1.8 years (range: 1.5-5.1 years). In this technique, we put a ring-shaped prosthetic graft in subannular position and sandwiched the aortic valve annulus between the prosthetic valve and graft with vertical mattress sutures. We consider that the subannular ring may be effective in distributing the stress to the annulus and the vertical mattress suture may help in fixing the prosthesis to annulus tissue rigidly.