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. 2022 Dec 23;20(1):212.
doi: 10.3390/ijerph20010212.

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

Paolo Nardi  1 , Calogera Pisano  1 , Carlo Bassano  1 , Fabio Bertoldo  1 , Alessandro Cristian Salvati  1 , Dario Buioni  1 , Daniele Trombetti  1 , Laura Asta  1 , Mattia Scognamiglio  1 , Claudia Altieri  2 , Giovanni Ruvolo  1
Affiliations

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

Paolo Nardi et al. Int J Environ Res Public Health. .

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; aortic root surgery; ascending aorta replacement.

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Conflict of interest statement

All the authors declare that they have no competing financial interests or personal relationships that could have influenced the work reported in this paper.

Figures

Figure 1
Figure 1
Survival after Bentall operation (mean follow-up, 55 ± 24 (M 60.2) months).
Figure 2
Figure 2
Event-free survival after Bentall operation.
Figure 3
Figure 3
Freedom from late cardiac death (a); from endocarditis and redo operation (b); from stroke (c).
Figure 4
Figure 4
Survival stratified by biological vs. mechanical prostheses (a); concomitant CABG (b); presence of previous MI (c) (log rank, Mantel–Cox test). CABG: coronary artery bypass grafting; MI: myocardial infarction.
Figure 5
Figure 5
Freedom from endocarditis–redo operation stratified by biological vs. mechanical prostheses valved conduits (Mantel–Cox test).
Figure 6
Figure 6
Adverse-event-free survival stratified by concomitant CABG (Mantel–Cox test). CABG: coronary artery bypass grafting.
Figure 7
Figure 7
Event-free survival stratified by biological vs. mechanical prostheses valved conduits (Mantel–Cox test).
See this image and copyright information in PMC

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