Long-term Outcomes of Modified Bentall Procedure

Abstract

Introduction: The aim of this study is to compare various modifications of Bentall procedure for early complications and long-term follow-up results. Patients and Methods: One hundred forty-nine patients underwent proximal aortic root replacement with composite valve-conduit graft between 1995 and 2014. Bentall procedure and its modifications (Cabrol procedure and hemi-inclusion) were evaluated for short- and long-term outcomes. Patients with concomitant procedures, arch repair, or valve-sparing procedures were excluded from the study. Results: In this study, 64 patients have met the inclusion criteria: 20 patients were included in the button Bentall group, 32 patients in the hemi-inclusion Bentall group, and 12 patients in the Cabrol group. Preoperative patient demographics were similar in all groups. The hemi-inclusion technique had better early outcomes, including less intraoperative blood transfusion, short cardiopulmonary bypass, and better in-hospital mortality rates (p< 0.05). However, the long-term all-cause mortality rates did not differ between the groups (p> 0.05). Conclusion: The hemi-inclusion Bentall technique might be used as a safe alternative approach for various aortic root diseases due to better hemostatic properties and lesser in-hospital mortality rates.

Keywords

• Aorta
• aortic valve
• hemorrhage

Modifiye Bentall Prosedürlerinin Uzun Dönem Sonuçları

Abstract

Giriş: Bu retrospektif çalışmanın amacı, aort kökü hastalığı olan hastalarda Bentall prosedürleri çeşitli modifikasyonlarının kısa ve uzun dönem sonuçlarını araştırmaktır. Hastalar ve Yöntem: 1995-2014 yılları arasında 149 hastaya kompozit kapak-tup grefti ile proksimal aort kökü replasmanı yapıldı. Bentall prosedürü ve modifikasyonları (Cabrol prosedürü ve Hemi-inklüzyon) kısa ve uzun dönem sonuçları açısından değerlendirildi. Eşlik eden prosedürler, ark tamiri veya kapak koruyucu prosedürleri olan hastalar çalışma dışı bırakıldı. Bulgular: Hastaların 64’ü dahil edilme kriterlerini karşılamıştır (Buton Bentall grubunda 20 hasta, Hemi-inklüzyon Bentall grubunda 32 hasta, Cabrol grubunda 12 hasta). Preoperatif demografik veriler tüm gruplarda benzer bulunmuştur. Hemi-inklüzyon tekniği, daha az intraoperatif kan kaybı ve transfüzyon gereksinimi, kısa kardiyopulmoner bypass ve daha iyi hastane içi mortalite gibi kısa dönem sonuçlarla sonuçlanmıştır (p< 0.05). Uzun dönemli tüm nedenlere bağlı mortalite oranları açısından gruplar arasında fark bulunmamıştır (p> 0.05). Sonuç: Hemi-inklüzyon Bentall tekniği, daha iyi hemostatik özellikler ve daha az hastane içi mortalite oranları nedeniyle çeşitli aort kökü hastalıkları için güvenli bir alternatif yaklaşım olarak kullanılabilir.

Keywords

• Aorta
• aort kapak
• kanama

References

1. 1. Mookhoek A, Korteland NM, Arabkhani B, Di Centa I, Lansac E, Bekkers JA, et al. Bentall procedure: a systematic review and meta-analysis. Ann Thorac Surg 2016;101:1684-9.
2. 2. Wallen T, Habertheuer A, Bavaria JE, Hughes GC, Badhwar V, Jacobs JP, et al. Elective aortic root replacement in North America: analysis of STS adult cardiac surgery database. Ann Thorac Surg 2019;107:1307-12.
3. 3. Kawazoe K, Eishi K, Kawashima Y. New modified Bentall procedure: carrel patch and inclusion technique. Ann Thorac Surg 1993;55:1578-9.
4. 4. Yakut C. A new modified Bentall procedure: the flanged technique. Ann Thorac Surg 2001;71:2050-2.
5. 5. Albertini A, Dell’Amore A, Zussa C, Lamarra M. Modified Bentall operation: the double sewing ring technique. Eur J Cardiothorac Surg 2007;32:804-6.
6. 6. Cebi N, Fromke J, Walterbusch G. Safe hemostasis by application of a new strict graft inclusion technique for replacement of the aortic root. Ann Thorac Surg 2003;76:631-2.
7. 7. Pratali S, Milano A, Codecasa R, De Carlo M, Borzoni G, Bortolotti U. Improving hemostasis during replacement of the ascending aorta and aortic valve with a composite graft. Tex Heart Inst J 2000;27:246-9.
8. 8. Kaskar A, Bohra DV, Rao KR, Shetty V, Shetty D. Primary or secondary Bentall-De Bono procedure: are the outcomes worse? Asian Cardiovasc Thorac Ann 2019;27(4):271-7.

9. 9. Patel ND, Weiss ES, Alejo DE, Nwakanma LU, Williams JA, Dietz HC, et al. Aortic root operations for Marfan syndrome: a comparison of the Bentall and valve-sparing procedures. Ann Thorac Surg 2008;85:2003-10.
10. 10. Akins CW, Miller DC, Turina MI, Kouchoukos NT, Blackstone EH, Grunkemeier GL, et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Eur J Cardiothorac Surg 2008;33:523-8.
11. 11. Gaudino M, Lau C, Munjal M, Avgerinos D, Girardi LN. Contemporary outcomes of surgery for aortic root aneurysms: A propensity-matched comparison of valve-sparing and composite valve graft replacement. J Thorac Cardiovasc Surg 2015;150:1120-9.
12. 12. Kim TS, Na CY, Oh SS, Kim JH. Long-term mortality and morbidity after button Bentall operation. J Card Surg 2013;28:280-4.
13. 13. Della Corte A, Baldascino F, La Marca F, Scardone M, Nappi G, Cefarelli M, et al. Hemostatic modifications of the Bentall procedure: imbricated proximal suture and fibrin sealant reduce postoperative morbidity and mortality rates. Tex Heart Inst J 2012;39:206-10.
14. 14. Apaydin AZ, Posacioglu H, Islamoglu F, Calkavur T, Yagdi T, Buket S, et al. Analysis of perioperative risk factors in mortality and morbidity after modified Bentall operation. Jpn Heart J 2002;43:151-7.
15. 15. Galicia-Tornell MM, Marin-Solis B, Fuentes-Orozco C, Martinez-Martinez M, Villalpando-Mendoza E, Ramirez-Orozco F. Bentall procedure in ascending aortic aneurysm: hospital mortality. Cir Cir 2010;78:45-51.