Long-term survival and operative outcomes of the Bentall procedure for aortic root aneurysm, aortic dissection, and endocarditis.
Academic Article
Overview
abstract
OBJECTIVE: To assess outcomes after aortic root replacement with Bentall procedure for aortic aneurysm, dissection, and endocarditis. METHODS: We identified consecutive patients undergoing Bentall procedures from 1997 to 2023, with stratification based on the primary diagnosis. Operative outcomes and long-term survival were compared. RESULTS: Of 1493 patients, 1378 (92.3%) underwent surgery for aneurysms, 75 (5%) for dissections, and 40 (2.7%) for endocarditis. The aneurysm group was older (61 years [range, 50-70 years] vs 57 years [range, 47-66.5 years] vs 56 years [range, 49-64 years]; P = .024). Patients with dissection or endocarditis had more preoperative myocardial infarctions (7.4% vs 12% vs 17.5%; P = .026), cerebrovascular accidents (9.6% vs 18.7% vs 45%; P < .001), renal dysfunction (8.3% vs 22.7% vs 45%; P < .001), shock (0.1% vs 10.7% vs 15%; P < .001), and ruptures (0.4% vs 10.7% vs 10%; P < .001). Regarding outcomes, acute renal failure (0.6% vs 1.3% vs 7.5%; P < .001) and operative mortality (0.4% vs 1.3% vs 7.5%; P = .001) were higher for endocarditis. Reexploration for bleeding was highest for dissections (4.1% vs 12% vs 2.5%; P = .004). Ten-year survival was similar between groups (71.8% vs 67% vs 83.7%; P = .94), with mean follow-up 68.2 ± 2.08 months. Multivariable analysis found age (hazard ratio [HR], 1.04; 95% CI, 1.03-1.05; P < .001), chronic obstructive pulmonary disease (HR, 2.12; 95% CI, 1.44-3.11; P < .001), renal dysfunction (HR, 1.97; 95% CI, 1.4-2.78; P < .001), and ejection fraction (HR, 0.97; 95% CI, 0.95-0.98; P < .001) were associated with late mortality but primary diagnosis was not. CONCLUSIONS: The Bentall procedure can be performed with low operative risk for aneurysms and selected dissections. Endocarditis is associated with higher but acceptable operative mortality. Excellent long-term survival can be expected after surviving initial operative risk.
