Long-Term Mortality and Morbidity after Button Bentall Operation

Kim, Tae Sik; Na, Chan-Young; Oh, Sam Sae; Kim, Jae Hyun

doi:10.1111/jocs.12085

Cited by 15 publications

(16 citation statements)

References 13 publications

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“…Our hospital mortality of 1% is comparable to other reports of aortic valve sparing root replacement (0.9-1%) (17,18); and less or equivalent to Bentall surgery (between 3% and 11%) (4)(5)(6)(7).…”

Section: Discussionsupporting

confidence: 83%

“…There were no bleeding events in our series. Valve-related complications after VSRR are fewer compared with Bentall procedure which, in the literature, arose with a frequency of 13% for reoperation, 7% for nonstructural dysfunction, 4-18% for thromboembolic events, 12% for endocarditis, 9-13% for bleeding events (5,8,9,19).…”

Section: Discussionmentioning

confidence: 99%

“…All-cause mortality and valve-related complications were not significantly different between these two types of prostheses (9). However, a potential shortcoming to this procedure is the risk of valve-related events: reoperation, particularly structural deterioration for biologic valves, bleeding (9-11%) and thromboembolism (4-11%) for mechanical aortic valve (5,8). The linearized rate for valve/ascending aorta reoperation was 0.86% after Bentall procedure with mechanical valves and 2.5% after Bentall with the bioprosthetic valve (8).…”

Section: Introductionmentioning

confidence: 95%

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Valve-sparing aortic root replacement—midterm outcomes and quality of life

Bata¹,

D’Ostrevy²,

Pereira³

et al. 2017

Cardiovasc. Diagn. Ther.

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Background: This study evaluated the midterm outcomes, the valve related events and quality of life of patients treated by valve-sparing aortic root replacement (VSRR). Results: Hospital mortality was 1%. There were 10 late deaths (11%) including 5 cardiac cases. Two patients (2%) required an aortic valve or graft prosthesis reoperation. Aortic valve endocarditis occurred in two patients. Thromboembolic events were reported in three patients. None of the following morbidity has been observed: structural valve deterioration, nonstructural dysfunction, valve thrombosis, bleeding event.The 5-and 8-year survival were 92% and 88%, respectively. The 8-year survival free from cardiac death was 88%. The mean of EuroQoL visual analogue scale (EQ VAS) and EQ index were respectively 83±15 (range 30-100) and 0.94±0.12 (range 0.5-1).Conclusions: Eight-year clinical improvement, function of the spared aortic valve and quality of life after valve sparing aortic root surgery appear excellent.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

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Valve-sparing aortic root replacement—midterm outcomes and quality of life

Bata¹,

D’Ostrevy²,

Pereira³

et al. 2017

Cardiovasc. Diagn. Ther.

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“…Although this procedure has become widespread, there are only a few very long term follow-ups available in the clinical literature. We evaluated the long-term clinical outcomes and sought to determine the independent predictors of long-term mortality for the button Bentall procedure in 147 patients [ 2 ]. We analyzed the independent risk factors of long-term mortality in a subdivided Marfan population too.…”

Section: Introductionmentioning

confidence: 99%

Bentall procedure: quarter century of clinical experiences of a single surgeon

Benke

Ágg

Szabó

et al. 2016

J Cardiothorac Surg

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BackgroundWe retrospectively analyzed 25 years of experiences with the button Bentall procedure in patients with aortic root pathologies. Even though this procedure has become widespread, there are only a few very long term follow-ups available in the clinical literature, especially regarding single surgeon results.MethodsBetween 1988 and 2013, a total of 147 patients underwent the Bentall procedure by the same surgeon. Among them there were 62 patients with Marfan syndrome. At the time of the surgery the mean age was 46.5 ± 17.6 years. The impact of surgical experience on long-term survival was evaluated using a cumulative sum analysis chart.ResultsThe Kaplan-Meier estimated overall survival rates for the 147 patients were 91.8 ± 2.3 %, 84.3 ± 3.1 %, 76.3 ± 4.9 % and 59.5 ± 10.7 % at 1,5,10 and 20 years, respectively. Multivariate Cox regression analysis identified EuroSCORE II over 3 % (OR 4.245, 95 % CI, 1.739–10.364, p = 0.002), acute indication (OR 2.942, 95 % CI, 1.158–7.480, p = 0.023), use of deep hypothermic circulatory arrest (OR 3.267, 95 % CI, 1.283–8.323, p = 0.013), chronic kidney disease (OR 6.865, 95 % CI, 1.339–35.189, p = 0.021) and early complication (OR 3.134, 95 % CI, 1.246–7.883, p = 0.015) as significant risk factors for the late overall death. The survival rate for freedom from early complication was 94.3 ± 2.2 %, 88.0 ± 3.3 %, 82.9 ± 4.7 % and 69.2 ± 8.4 % at 1,5,10 and 20 years. The main pathological findings of the aortic wall were cystic medial degeneration in 75 %, fibrosis in 6 %, atherosclerosis in 13 % and no pathological alteration in 6 % of the samples. The overall survival rate was significantly lower in patients operated in first 15 years compared to patients operated in the last decade (log-rank p = 0.011).ConclusionAccording to our long-term follow-up the Bentall operation provides an appropriate functional result by resolving the lesions of the ascending aorta. Based on our results, 25–30 operations done is necessary to gain such a level of confidence and experince to aquire better results on long-term survival. In addition, we discussed that there were no co-morbidities affecting on the survival of Marfan patients and prophylactic aortic root replacement ensures a longer survival among patients with Marfan syndrome.

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“…Long-term mortality of the Button Bentall method was shown to be related to embolism and bleeding events similar to valve surgery. Contaminant CABG also increased bleeding risk for patients undergoing the Bentall procedure [10]. Midulla and colleagues comment that late mortality in patients is often due to a subsequent aneurysm or dissection along the aorta even in patients not presenting with a genetic defect affecting aortic structure.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Ascending Aortic Aneurysm and Its Complications

Sran

Ferguson

et al. 2014

Case Reports in Vascular Medicine

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Ascending aortic aneurysms involving the proximal aortic arch, arising anywhere from the aortic valve to the innominate artery, represent various problems in which open surgery is generally required. Surgical options include excision of the aortic pathology or wrapping the aneurysm shell with an aortic Dacron graft. Intervention using the latter method can lead to extravasation of blood along the suture lines resulting in continuous bleeding within the periprosthetic space. The Cabrol technique was developed as a method for decompression of postoperative leaks by the formation of a conduit system from the periprosthetic space to the right atrium. The coronary ostia are anastomosed to a second graft in an end-to-end fashion, which is then anastomosed to the ascending aortic conduit side to side. The native aorta is then sewn around the prosthesis, hereby creating a shunt to drain anastomotic leakage. This shunt reduces postsurgical risk of pseudoaneurysm formation and normally closes a few days following surgery. We discuss the case of a patient who underwent Cabrol's variation and six months later was demonstrated to have a patent shunt.

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Long-Term Mortality and Morbidity after Button Bentall Operation

Abstract: Valve-related morbidities, such as embolism and bleeding, determine the long-term overall mortality in aortic root replacement with button Bentall operation, similar to that in routine valve surgery.

Cited by 15 publications

References 13 publications

Valve-sparing aortic root replacement—midterm outcomes and quality of life

Valve-sparing aortic root replacement—midterm outcomes and quality of life

Bentall procedure: quarter century of clinical experiences of a single surgeon

Surgical Management of Ascending Aortic Aneurysm and Its Complications

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