Bentall Operation: Early Surgical Results, Seven-Year Outcomes, and Risk Factors Analysis

Abstract

aim: to analyze early and mid-term outcomes of the bentall operation. methods: two hundred and seventeen patients (mean age 65.6 ± 15.9 years, males/females 172/45) underwent Bentall operation in a 7-year period (january 2015−december 2021), on average, 30 bentall operations occurred per year, using biological (n = 104) or mechanical (n = 113) valved conduits for the treatment of ascending aorta−aortic root aneurysms. associate procedures were performed in 58 patients (26.7%); coronary artery bypass grafting (CABG) in 35 (16%). mean follow-up was 55.2 ± 24 (median 60.2) months. cox model analysis was used to assess risk factors, kaplan−meier and log-rank tests were used to assess different survival rates. results: operative mortality was 1.38%. At 7 years, survival, freedom from cardiac death, and event-free survival were 93% ± 2%, 99% ± 1%, and 81% ± 5%. NYHA class (p < 0.0001), trans-aortic valve mean (p < 0.0001) and maximum (p < 0.000) gradients, left ventricular hypertrophy (p < 0.05), and pulmonary arterial pressure (p = 0.002) significantly improved vs. preoperative values. concomitant CABG during bentall operation independently affected late outcomes (HR 1.9−2.3; p-values < 0.05). late survival was affected by concomitant CABG (84% ± 8% vs. 95% ± 2%, p = 0.04), preoperative myocardial infarction (91% ± 9% vs. 97% ± 2%, p = 0.02), and biological vs. mechanical prostheses valved conduits (91% ± 9% vs. 95% ± 3%, p = 0.02). Event-free survival also was affected by concomitant CABG (62% ± 14% vs. 85% ± 5%, p = 0.005) and biological prostheses (78% ± 8% vs. 84% ± 6%, p = 0.06). Freedom from endocarditis−redo operation was 83% ± 9% for biological prostheses vs. 89% ± 6% for mechanical prostheses (p = 0.49). conclusions: Low rates of operative mortality and late complications make bentall operation the gold standard for the treatment of ascending aorta−aortic root aneurysms. coronary ischemic disease affects late outcomes. biological prostheses should be preferred for the elderly.