What is Wheat's procedure in cardiac surgery?

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Wheat's Procedure in Cardiac Surgery

The Wheat procedure is a surgical technique for treating aortic valve disease with mild to moderate ascending aortic dilation, involving separate aortic valve replacement and supracoronary ascending aortic replacement while preserving the native aortic root and coronary ostia. 1, 2

Definition and Indications

The Wheat procedure is characterized by:

  • Separate replacement of the aortic valve and the ascending aorta
  • Preservation of the native aortic root and coronary ostia
  • Typically used when aortic root dimensions are only mildly to moderately dilated (around 40-45mm)

This procedure differs from the Bentall procedure, which involves complete replacement of the aortic valve, aortic root, and ascending aorta with a composite graft-valve device and reimplantation of the coronary ostia into the sides of the conduit 3.

Surgical Technique

The Wheat procedure involves:

  1. Replacement of the diseased aortic valve with a prosthetic valve (mechanical or tissue)
  2. Separate replacement of the ascending aorta with a vascular graft
  3. The native aortic root containing the coronary ostia remains intact
  4. The distal anastomosis is performed at the level of the distal ascending aorta

Clinical Applications

The Wheat procedure is primarily indicated for:

  • Patients with aortic valve disease (stenosis or regurgitation) requiring valve replacement
  • Concurrent mild to moderate dilation of the ascending aorta (typically 40-45mm)
  • Cases where the aortic root is relatively normal or only mildly dilated
  • Bicuspid aortic valve patients with associated ascending aortopathy 2

Advantages and Limitations

Advantages:

  • Simpler and faster procedure compared to the Bentall operation
  • Shorter aortic cross-clamp and cardiopulmonary bypass times 2
  • Less bleeding risk in the immediate postoperative period
  • Avoids the technical complexity of coronary reimplantation

Limitations:

  • Risk of subsequent aortic root aneurysm development if the aortic root is already dilated
  • May require reoperation if aortic root dilation progresses over time
  • Not suitable for patients with significant aortic root pathology

Follow-up Considerations

Regular follow-up is essential after the Wheat procedure:

  • Routine echocardiography to assess valve function and aortic root dimensions
  • Periodic CT imaging to monitor the entire aorta
  • Close surveillance particularly important in patients with initial aortic root dilation

Comparison with Other Aortic Procedures

  • Bentall Procedure: Complete replacement of aortic valve, root, and ascending aorta with coronary reimplantation 3, 4
  • David Procedure: Valve-sparing aortic root replacement that preserves the native aortic valve
  • Yacoub Procedure: Another valve-sparing technique focusing on remodeling the aortic root

Potential Complications

A case report has documented the development of aortic root aneurysm after the Wheat procedure, highlighting the importance of regular imaging follow-up, particularly in patients with underlying connective tissue disorders or those with initial aortic root dilation 1.

The development of subsequent aortic root aneurysm requiring reoperation has been reported approximately 40 months after the initial Wheat procedure in some cases, necessitating more extensive surgery such as the Bentall procedure 1.

Regular monitoring with chest CT and echocardiography is crucial for early detection of potential complications, especially in patients who had slight dilation of the aortic root at the time of the initial Wheat procedure.

References

1
Research

Surgical case of aortic root and thoracic aortic aneurysm after the Wheat procedure.

Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 2002

3
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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