Modified Bentall Procedure with Composite Biologic Grafts

Yang, Jixiang; Neely, Robert C.; Stewart, Allan

doi:10.1111/jocs.12216

Cited by 4 publications

(5 citation statements)

References 9 publications

(11 reference statements)

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“…Peak transvalvular gradient at hospital discharge was 20.03 ± 6.09 mmHg (range 11-39 mmHg). related to the adopted double sewing ring technique [17,18]. Taking advantage from other's and our personal experience with more than 120 implants of 3F prosthesis, a stentless valve made by three equal sections of equine pericardium assembled in a tubular structure on a thin polyester sewing ring [19], we began to implant the self-assembled 3F bioroot in 2010, using the previously described surgical technique.…”

Section: Resultsmentioning

confidence: 99%

Intermediate-Term Outcomes of 3F Stentless Bioroot for Bentall Operation

Stefanelli¹,

Pirro²,

Luigi³

et al. 2021

Int J Clin Cardiol

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Background: Aim of this study was to assess the intermediate-term outcome after Bentall operation using a self-assembled bio-root conduit containing a 3F stentless valve. Between April 2010 and August, 2015, 30 patients affected by aortic root dilatation with aortic valve disease underwent Bentall operation at our Unit, using a conduit assembled by including a 3F ® stentless valve into a straight woven tube graft. Mean age at surgery was 66.3 yrs. Mean Logistic EUROscore was 10.01. Mean pre-operative Ejection Fraction was 54.50%. Two patients (6.3%) had undergone a previous operation. Three patients (10%) had a bicuspid valve. Five patients (16.6%) received an associate procedure. Mean size of bio-root was 28.93. Mean ischemic time was 101.43', mean CPB time 127'.Results: All patients were evaluated by echocardiogram and clinical examination at discharge and annually. Median follow-up time was 6.94 years. Primary end points of our analysis consisted of early and late mortality, freedom from ABE and MACCE, freedom from SVD and freedom from valve-related reoperation. Early mortality was 0%. Two patients died during follow-up, one for cardiac causes.

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Section: Resultsmentioning

confidence: 99%

Intermediate-Term Outcomes of 3F Stentless Bioroot for Bentall Operation

Stefanelli¹,

Pirro²,

Luigi³

et al. 2021

Int J Clin Cardiol

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“…Therefore, we think it is better to sew between the cuff and the aortic annulus rather than to sew the sewing ring with the annulus. Yang et al 14 reported an alternative technique of performing the proximal anastomosis with continuous sutures between the Dacron graft and the aortic annulus, this technique could reduce the aortic cross-clamp time but the annulus tissue must be firm. Our study found that the commercially available graft significantly increased the risk of reoperation for bleeding and had worse survival outcomes compared to the self-assembled graft.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Until now, there are numerous modifications of the original Bentall procedure to reduce postoperative bleeding and other conduit-related complications. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Among those, Kouchoukos et al 5 described the "button technique" in which two coronary ostia were detached, adequately mobilized, and reattached to the conduit. This modified technique has been shown to reduce the risk of pseudoaneurysm in the proximal anastomosis and coronary ostia due to suture dehiscence.…”

Section: Introductionmentioning

confidence: 99%

Modified Bentall procedure: A 15-year single-center clinical experience

Van

Pham²,

Chau³

et al. 2022

Asian Cardiovasc Thorac Ann

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Objective Bentall procedure is a standard technique for complete aortic root replacement but a huge challenge is postoperative bleeding. Many modifications have been proposed and the “button technique” is commonly used. With a 15-year experience, this study was to evaluate outcomes of this modified Bentall procedure. Methods A retrospective study was performed with all patients who underwent the Bentall procedure with a button technique between 2005 and 2020. Commercially available composite grafts were used in 38 patients and self-assembled composite graft was used in 74 patients. Safety outcome was postoperative complications and long-term outcomes included overall and reoperation-free survivals. Results Among 112 patients, the mean age was 46.3 years and 69.6% were men. Indications for the Bentall procedure were ascending aortic aneurysm and valve regurgitation (59.8%), aortic dissection (19.6%), Marfan syndrome (17%), and endocarditis (3.6%). Three patients (2.7%) died in hospital. During a median follow-up period of 42 months, 11 patients died and 7 patients required reoperation. Overall survival and reoperation-free survival were 86.1% and 83.4% at 5 years and 86.1% and 72.6% at 10 years, respectively. Conclusions The Bentall procedure with a button technique is safe and effective for aortic root replacement. Further investigations are required to improve the feasibility and effectiveness of the procedure.

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“…A stentless bio‐Bentall operation may represent, in young and active patients who wish to avoid anticoagulation, 6–9 a valid alternative to homograft, often difficult to supply in most cardiac units, 10 and to the Ross operation 11 that requires a certain amount of surgical training and skill. Valve sparing procedures, introduced by David 3 and Yacoub 4 in the early 1990s, remain a valid alternative to Bentall in selected cases, and have proven excellent long‐term results in several reported large series of patients 12 .…”

Section: Discussionmentioning

confidence: 99%

Mid‐term outcomes of stentless Bio‐Bentall vs. David Reimplantation for aortic root replacement

Stefanelli

Pirro

Chiurlia

et al. 2022

Journal of Cardiac Surgery

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Objective To compare the early and midterm clinical outcomes of patients undergoing two different surgical procedures (stentless biological Bentall [SBB] vs. valve‐sparing David Reimplantation [VSDR]) for aortic root dilatation, with or without concomitant aortic valve pathology. Methods A population of 106 patients underwent aortic root replacement from 2004 to 2015 at our unit. Mean age at operation was 63.1 ± 10 years. The patients were retrospectively assigned to 2 groups according to surgical procedure. David operation was carried out in 52 patients (group A‐VSDR) and stentless biological Bentall in 54 patients (group B‐SBB). Preoperative characteristics were similar in the 2 cohorts, except for age and EuroSCORE. Mean follow‐up time was 7.09 years (0.26–14.50 years), and 96% complete. Patients were evaluated and analyzed for intra‐operative results and long‐term clinical outcomes. Results Intraoperative mortality was 0% in both groups. Overall survival probability at 11 years was 91.8% in group A and 73.8% in group B (p = .004). Cardiac mortality at 11 years was similar in the 2 groups (p = .116). Freedom from structural valve deterioration at 11 years was 88.8% (VSDR) and 90.6% (SBB) [p = .689]. Freedom from reoperation at 11 years did not differ between the groups (83.6% VSDR vs. 98.5% SBB, p = .574). Freedom from major adverse cardiac and cerebrovascular events at 11 years was 76.7% (VSDR) versus 80.1% (SBB) (p = .542). Mean gradient at last follow‐up was lower in VSDR group (8.13 vs. 11.70 mmHg, p < .001). Conclusions David reimplantation and stentless biological Bentall procedures achieve excellent and comparable results at midterm follow‐up. David operations provide superior hemodynamic performance preserved over time and may be preferred in younger, active patients.

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Modified Bentall Procedure with Composite Biologic Grafts

Abstract: Our experience with Gen2 CBG showed decreased operative times and a trend toward improved survival, though further patient follow-up and larger sample sizes in prospective studies are necessary. Further research with this CBG and additional improvements are warranted.

Cited by 4 publications

References 9 publications

Intermediate-Term Outcomes of 3F Stentless Bioroot for Bentall Operation

Intermediate-Term Outcomes of 3F Stentless Bioroot for Bentall Operation

Modified Bentall procedure: A 15-year single-center clinical experience

Mid‐term outcomes of stentless Bio‐Bentall vs. David Reimplantation for aortic root replacement

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