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

Paolo Nardi (), Calogera Pisano, Carlo Bassano, Fabio Bertoldo, Alessandro Cristian Salvati, Dario Buioni, Daniele Trombetti, Laura Asta, Mattia Scognamiglio, Claudia Altieri and Giovanni Ruvolo
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Paolo Nardi: Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
Calogera Pisano: Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
Carlo Bassano: Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
Fabio Bertoldo: Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
Alessandro Cristian Salvati: Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
Dario Buioni: Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
Daniele Trombetti: Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
Laura Asta: Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
Mattia Scognamiglio: Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
Claudia Altieri: Cardiology Unit of the Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
Giovanni Ruvolo: Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy

IJERPH, 2022, vol. 20, issue 1, 1-12

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.

Keywords: Bentall operation; ascending aorta replacement; aortic root surgery (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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