Antonella Galeone, n/a: No financial relationships to disclose
Purpose: The Bentall procedure represents the gold standard therapy in patients with ascending aorta or aortic root aneurysm combined with aortic valve disease precluding a valve-sparing procedure. In this study we evaluated the early and long-term results of Bentall procedure over a twenty-year period. Methods: All consecutive patients undergoing Bentall procedure with either a mechanical or biological valved conduit at our Institution between January 2001 and December 2022 were included in the study. Patient’s characteristics, perioperative data and in-hospital outcomes were retrospectively reviewed from patient’s paper-based and electronic medical records. Follow-up data were collected until June 2023 via phone and e-mail contact with patients, family members, family physisicians and cardiologists. Clinical outcomes of interest included mortality and reintervention. The Kaplan–Meier method was used to draw survival curves, and the log-rank test was used to compare survival among groups. Results: 540 patients underwent Bentall procedure with a biological (n=348, 64%) or a mechanical (n=192, 36%) valved conduit during the study period. Patients with mechanical Bentall were significantly younger compared to patients with biological Bentall (table 1). Main indications for surgery were aortic aneurysm (n=419, 77%) and acute aortic dissection (n=80, 15%). 101 (19%) patients underwent urgent/emergent surgery. Sixteen (3%) patients required postoperative IABP or ECMO. 203 patients died during the follow-up. We recorded 26 (5%) periprocedural, 17 (3%) early and 160 (30%) late death. Overall mean survival was 14.9±0.4 years, survival rates were 96.1% at 30 days, 92% at 1 year, 82,8% at 5 years, 70,5% at 10 years and 54,2% at 15 years, 44.6% at 20 years. Mean survival time was significantly better in patients with mechanical Bentall compared to patients with biological Bentall (16.2±0.6 vs 13.7±0.5 years; p< 0.001) (figure 1). Mean survival time was significantly better in elective surgery compared to urgent/emergent surgery (15.4±0.4 vs 12.8±1 years; p=0.01). Sixteen (3%) patients, 10 (3%) with biological Bentall and 6 (3%) with mechanical Bentall required a reoperation during the follow-up for infective endocarditis (n=11), chronic dissection of the aortic arch (n=2), mitral regurgitation (n=2) and structural valve dysfunction (n=1). Conclusion: Bentall operation is a safe procedure for the treatment for ascending aorta disease with good early and long-term survival and low rate of re-operation. Bentall procedure presents satisfactory results in an all-comer series with low mortality when electively performed but remains a high-risk procedure when performed in urgent or emergent cases. Mechanical valved conduits are associated with better survival rates.
Identify the source of the funding for this research project: No funding was received for this study
