Clinical Experience with the Bentall Procedure: 28 Years

Abstract

PurposeWe retrospectively analyzed 28 years of experience with the Bentall procedure in patients with aortic valve, aortic root, and ascending aortic disease.Materials and MethodsBetween March 1982 and December 2010, a total of 218 patients underwent the Bentall procedure using a composite valved conduit. The "inclusion technique" was used in 30 patients (13.8%), the "open-button technique" in 181 patients (83.0%), and the Cabrol technique in 7 patients (3.2%).ResultsThe early mortality rate was 5.5% (12/218). The mean follow-up duration was 108.0±81.0 months (range: 1-329 months). Seven patients required re-operation, and 1 patient required stent graft insertion at the descending thoracic aorta for progression of aortic arch or descending thoracic aortic dissection or aneurysm after the first operation, and 5 of them had Marfan syndrome. Kaplan-Meier estimated survival rates at 1, 5, 10, 20, and 25 years were 90.4%, 82.7%, 77.6%, 65.3%, and 60.3%, respectively. Freedom from reoperation rates at 1, 5, 10, 20, and 25 years were 99.0%, 98.3%, 95.5%, 90.8%, and 90.8%, respectively.ConclusionIn our experience, the Bentall procedure provided optimal survival with improved functional status. The disease of the aorta may progress, especially in patients with Marfan syndrome. Therefore, careful follow-up with regular computed tomography angiograms should be performed in these patients.

Longevity after mechanical aortic root replacement—do men live longer?

“…Joo and colleagues 23 reported a hospital mortality of 5.5% in 12 patients, with the mean cause low cardiac output syndrome in 3 (25%), arrhythmia in 3 (25%), pneumonia in 2 (17%), sepsis in 2 (17%), and others.…”

Safety of Comprehensive Aortic Root and Valve Repair Surgery: A Retrospective Outcomes Research by National Evidence-Based Health Care Collaborating Agency, Korea

“…In a recently reported 28 years experience (from 1982) of the Bentall procedure, the operative mortality was 5.5%, and risk of late reoperation and endocarditis were 3.2% and 1.4% respectively 6). Moreover, Lim et al6) reported that, in patients with aortic root dilatation with advanced aortic regurgitation, operative mortality was 2.4% in the Bentall procedure group and 0% in the valve-sparing operation group 7). Compared with those data, in patients with CARVAR surgery, mortality seems quite higher than recently reported results and the risk of endocarditis and re-operation are much higher than in previous reports.…”

Percutaneous treatment of late complications of the Bentall procedure

“…Several studies have shown that long‐term survival is improved with the open‐button technique. However, despite these technical modifications of the Bentall procedure, complications have not been completely eliminated . The interval between the initial procedure and the development of pseudo‐aneurysm can be long, up to 17 years .…”