Factors associated with mortality and long time survival in patients undergoing modified Bentall operations

We report our results on mortality, morbidity and long time events after composite graft replacement of the aortic root and ascending aorta/aortic arch and factors associated with them.

Seventy-four patients, aged 52 years (15-73) underwent modified ''button'' Bentall operation. The indication for operation was acute dissection in 29 (39%) patients, chronic dissection in 3 (4%), aortic regurgitation after previous replacement of the ascending aorta because of aortic dissection in 2 (3%) and non dissecting aneurysm in 40 (54%). Concommitant procedures were (partial) replacement of the aortic arch in 11 (15%) and coronary artery bypass grafting in 5 (7%). Six patients (8%) had undergone previous cardiac surgery. Mean follow up was for 49 +/- 46 months (maximum 198).

Length of intensive care unit (ICU) stay was 3 days (1-72). Hospital mortality was 12%. Factors significantly associated with hospital mortality were: aortic dissection, cardiopulmonary bypass time, aortic cross clamp time, deep hypothermic circulatory arrest, low cardiac output syndrome, revision due to bleeding, renal failure requiring hemofiltration, multisystemic organ failure and sepsis. None of these factors was significantly associated with long term survival. Survival rates including hospital deaths were 86%, 84%, 75% and 75% after 1, 3, 5 and 7 years respectively. Pseudoaneurysm at the composite graft occurred in 3%, infection of the prosthesis in 1%. Neither valve thrombosis nor thromboembolic events occurred postoperatively.

Modified Bentall operation is a demanding operation with acceptable hospital mortality. The long time survival rates are good and the big majority of patients is eventfree after operation.