The Modified Bentall Procedure: A Single-Institution Experience in 249 Patients with a Maximum Follow Up of 21.5 Years

Abstract

Background and aim of the study: The study aim was to evaluate the long-term clinical outcomes of the modified Bentall procedure (MBP) with a mechanical conduit.

Methods: Between 1993 and 2014, a total of 249 patients (mean age 62 ± 12 years; range: 25-87 years) underwent a MBP at the authors' institution. The main indication was annuloaortic ectasia in 102 patients (41%), followed by acute aortic dissection in 82 patients (33%); moderate to severe aortic regurgitation was present in 79% of cases. A bicuspid aortic valve was found in 17% of patients, and Marfan syndrome in 7%. The mean NYHA functional class was 2.5 ± 1.1. Concomitant procedures were performed in 36 patients (14%). The mean follow up was 8.7 ± 5.0 years (range: 0.3-21.5 years) and was 99% complete. The total follow up was 6.475 patient-years (pt-yr).

Results: Operative mortality was 3% in elective cases. Age, prolonged cardiopulmonary bypass times and mechanical ventilation >96 h were independent risk factors for early mortality. Actuarial survival at 15 and 20 years was 62% and 60%, respectively. Risk factors for late mortality were age and emergency operation. Actuarial freedom from thromboembolism (linearized incidence 0.93%/pt-yr) was 82% at 15 years, and 74% at 20 years. Seven patients required reoperation (0.38%/pt-yr), with an actuarial freedom from reoperation of 91% at 15 years and 87% at 20 years. The incidence of overall valve-related complications was 0.32%/pt-yr, with actuarial freedoms of 94% at 15 and 20 years.

Conclusions: The MBP has shown excellent long-term results with a low incidence of procedure-related complications up to 20 years postoperatively. For this reason, it is considered to be a valid option for the treatment of aortic root disease, whenever valvesparing procedures are not indicated.