Long-term Outcomes of Modified Bentall Procedure

Year 2020, Volume: 23 Issue: 2, 111 - 116, 16.08.2020

Emre Gök Murat Başaran

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. 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. 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. Kawazoe K, Eishi K, Kawashima Y. New modified Bentall procedure: carrel patch and inclusion technique. Ann Thorac Surg 1993;55:1578-9.
• 4. Yakut C. A new modified Bentall procedure: the flanged technique. Ann Thorac Surg 2001;71:2050-2.
• 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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.