Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 19;11(11):370.
doi: 10.3390/jcdd11110370.

The David Versus the Bentall Procedure for Acute Type A Aortic Dissection

Fausto Biancari  1 , Giorgio Mastroiacovo  1 , Mauro Rinaldi  2 , Luisa Ferrante  2 , Timo Mäkikallio  3 , Tatu Juvonen  4   5 , Giovanni Mariscalco  6 , Zein El-Dean  6 , Matteo Pettinari  7 , Javier Rodriguez Lega  8 , Angel G Pinto  8 , Andrea Perrotti  9 , Francesco Onorati  10 , Konrad Wisniewski  11 , Till Demal  12 , Petr Kacer  13 , Jan Rocek  13 , Dario Di Perna  14 , Igor Vendramin  15 , Daniela Piani  15 , Eduard Quintana  16 , Robert Pruna-Guillen  16 , Joscha Buech  17   18 , Caroline Radner  17   18 , Manoj Kuduvalli  19 , Amer Harky  19 , Antonio Fiore  20   21 , Angelo M Dell'Aquila  11   22 , Giuseppe Gatti  23 , Lenard Conradi  24 , Mark Field  19 , Arianna Galotta  25 , Daniele Fileccia  1 , Giuseppe Nanci  1 , Sven Peterss  17
Affiliations

The David Versus the Bentall Procedure for Acute Type A Aortic Dissection

Fausto Biancari et al. J Cardiovasc Dev Dis. .

Abstract

Background: Type A aortic dissection (TAAD) is a life-threatening condition which requires prompt diagnosis and surgical treatment. When TAAD involves the aortic root, aortic valve-sparing or Bentall procedures are the main surgical treatment options. Method: The subjects of this analysis were 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD). Propensity score matching was performed by estimating a propensity score from being treated with the Bentall or the David procedure using multilevel mixed-effects logistics, considering the cluster effect of the participating hospitals. Results: A Bentall procedure was performed in 862 patients, while a David operation was performed in 139 patients. The proportion of aortic root replacement, as well as the different techniques of aortic root replacement, varied significantly between the participating hospitals (p < 0.001). After propensity score matching, we obtained two groups of 115 patients each, and no statistical differences were reported in terms of postoperative outcomes, except for the rate of dialysis, which was higher in the patients requiring a Bentall procedure (17.4% vs. 7.0%, p-value 0.016). In the unmatched cohorts, the David procedure was associated with a lower 10-year mortality rate compared to the Bentall procedure (30.1% vs. 45.6%, p-value 0.004), but no difference was observed after matching (30.0% vs. 43.9%, p-value 0.082). After 10 years, no differences were observed in terms of proximal aortic reoperation (3.9% vs. 4.1%, p-value 0.954), even after propensity score matching (2.8% vs. 1.8%, p-value 0.994). Conclusions: The David and Bentall procedures are durable treatment methods for TAAD. When feasible, it is advisable that the David procedure is performed for acute TAAD by surgeons with experience with this demanding surgical technique.

Keywords: Bentall procedure; David procedure; aortic root; type A aortic dissection.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Proportions of different aortic root replacement procedures in the participating hospitals (p < 0.001 for all comparisons).
Figure 2
Figure 2
Mortality after the David procedure and the Bentall procedure in the overall series.
Figure 3
Figure 3
Mortality after the David procedure and the Bentall procedure among propensity score-matched patients.
See this image and copyright information in PMC

References

    1. Elsayed R.S., Cohen R.G., Fleischman F., Bowdish M.E. Acute type A aortic dissection. Cardiol. Clin. 2017;35:331–345. doi: 10.1016/j.ccl.2017.03.004. - DOI - PubMed
    1. Isselbacher E.M., Preventza O., Hamilton Black Iii J., Augoustides J.G., Beck A.W., Bolen M.A., Braverman A.C., Bray B.E., Brown-Zimmerman M.M., Chen E.P., et al. 2022 ACC/AHA Guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J. Am. Coll. Cardiol. 2022;80:e223–e393. doi: 10.1016/j.jacc.2022.08.004. - DOI - PMC - PubMed
    1. Arabkhani B., Verhoef J., Tomšič A., van Brakel T.J., Hjortnaes J., Klautz R.J.M. The aortic root in acute type A dissection: Repair or replace? Ann. Thorac. Surg. 2023;115:1396–1402. doi: 10.1016/j.athoracsur.2022.06.041. - DOI - PubMed
    1. Khachatryan Z., Herajärvi J., Leontyev S., Borger M.A. Valve-sparing aortic root replacement can be done safely and effectively in acute type A aortic dissection. J. Thorac. Cardiovasc. Surg. 2022;164:814–819. doi: 10.1016/j.jtcvs.2021.02.101. - DOI - PubMed
    1. Khachatryan Z., Leontyev S., Magomedov K., Haunschild J., Holzhey D.M., Misfeld M., Etz C.D., Borger M.A. Management of aortic root in type A dissection: Bentall approach. J. Card. Surg. 2021;36:1779–1785. doi: 10.1111/jocs.15271. - DOI - PubMed

LinkOut - more resources