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Long-term Results of Bentall Composite Aortic Root Replacement for Ascending Aortic Aneurysms and Dissections^*

^* From the Department of Cardiovascular Sciences, General Hospital "S. Maria Della Misericordia," Udine, Italy.

Correspondence to: Sandro Gelsomino, MD, Cardiothoracic Surgery, Department of Cardiovascular Sciences, Azienda Ospedaliera S. Maria della Misericordia, Piazzale S. Maria Della Misericordia 11, 33100 Udine, Italy; e-mail: sandrogelsomino{at}virgilio.it

Study objectives: The aim of this study was to evaluate the early and long-term outcomes in patients undergoing aortic root replacement (ARR) with the Bentall procedure.

Design: Retrospective study.

Setting: Cardiothoracic surgery unit.

Patients and methods: Between January 1986 and January 2002, 72 patients (mean age 58.3 ± 12.4 years, 81.9% males) underwent ARR by means of a Bentall operation. Annuloaortic ectasia was the most frequent cause of aortic disease in this series of patients (31 patients; 43.1%), followed by type A dissection (19 patients; 26.3%), atherosclerotic aneurysm (18 patients; 25.1%), and poststenotic dilatation (4 patients; 5.5%). Nine patients (12.5%) had Marfan syndrome, and 10 patients (13.8%) underwent a concomitant replacement of the aortic arch. Follow-up ranged from 2 to 192 months (mean [± SD], 86.6 ± 23.8 months).

Results: The mean 30-day mortality rate was 5.5 ± 2%. The mean early mortality rate was 21 ± 4% and 0% (p < 0.001), respectively, in patients with and without dissecting aortic aneurysms. There were two late deaths that were due to a pulmonary neoplasm and a cerebrovascular accident. The mean 16-year survival rate was 91.7 ± 3.2%. The mean hazard of freedom from death was constant beyond 3 years (8.5 ± 3.5%). No patient required reoperation. Furthermore, the long-term clinical follow-up was marked by a complete absence of endocarditis, anticoagulant-related hemorrhage, valve thrombosis, and prosthesis failure. Finally, patients showed a significant improvement in mean New York Heart Association functional status (1.3 ± 0.1; p < 0.001 [postoperatively vs preoperatively]).

Conclusions: In our experience, the late results of the Bentall operation were satisfactory. Our findings confirm that this technique still represents the procedure of choice for ARR with coronary reimplantation.

Key Words: aortic aneurysm • aortic root replacement • Bentall technique • composite graft • dissecting aneurysm

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