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[Long term survival with the Bentall button operation in 150 patients]
D Guilmet1, N Bonnet, J P Saal
1Service de chirurgie cardiovasculaire, HEP La Roseraie, 120, av. de la République, 93300 Aubervilliers Cedex.
Insights
This study on ascending aortic replacement using the button technique shows significantly improved long-term survival rates. The standardized surgical approach enhances patient outcomes for aortic disease and Marfan syndrome.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Context:
- Ascending aortic replacement is a complex procedure.
- The button technique for coronary reimplantation has evolved.
- Long-term outcomes for aortic root and ascending aorta pathologies require continuous evaluation.
Purpose:
- To evaluate the long-term outcomes of ascending aortic replacement using the button technique.
- To assess survival rates and complications associated with this surgical approach.
- To compare current results with previous institutional data.
Summary:
- A 20-year study (1980-2000) analyzed 150 patients undergoing ascending aortic replacement with the button technique.
- The procedure involved valvular conduit replacement and coronary reimplantation.
- Associated conditions included annulo-ectasia, Marfan syndrome, and aortic dissection.
Impact:
- The study reports significantly improved actuarial survival rates (85% at 10 years, 60% at 20 years) compared to previous data.
- Low operative mortality (0.6%) and acceptable rates of thrombosis, embolism, and hemorrhage were observed.
- The adoption of a single, standardized operative technique and improved myocardial protection strategies are credited for the enhanced prognosis.
Abstract:
Between May 1980 and May 2000, 150 patients (123 males and 27 females) underwent surgery with the same surgeon for ascending aortic replacement with a valvular conduit and coronary reimplantation with the aid of a collar of aortic wall (button technique). The average age was 50 +/- 16 years. Within this population, 114 patients had isolated annulo-ectasial disease, 36 had Marfan syndrome and 20 had dissection (5 acute and 15 chronic). A carbon fibre valve with 2 leaflets was implanted in 124 patients, a mono-leaflet valve in 20 and 6 others required a heterograft due to their age or a contra-indication to anticoagulation. The associated procedures were: 12 arch replacements, 5 myocardial revascularisations, 4 mitral replacements, 1 tricuspid plasty, 1 inter-atrial communication closure. In 30 patients (20%) there was a cardiovascular surgical re-intervention. The operative and first month mortality amounted to one sudden death on the 19th day, ie 0.6%. Three patients were lost to follow up. The average survival was 7.87 +/- 5.37 years (minimum 1, maximum 20 years). The actuarial survival was 85% at 10 years and 60% at 20 years. These figures are much higher than those reported in our previous statistics from 1994 when the percentage of survivors at 12 years was only 61%. In the group of patients undergoing surgery before 60 years of age, the survival at 14 years was 94% and 81% at 20 years. Only four late re-interventions were attributable to the Bentall procedure, of which 2 were left coronary ostium stenoses. The rate of thrombosis and embolism was 0.42 per 100 patient-years and the rate of haemorrhagic accidents was identical, including minor accidents. This considerable improvement in long-term prognosis is explicable by the adoption of a single operative technique, considered to be the best, with the best myocardial protection thanks to coronary retro-perfusion and cold or hot cardioplegia, and also without doubt with the best medical survival.
