Embolic and bleeding events after modified Bentall procedure in selected patients

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Valve-sparing procedures are gaining popularity.
• Long-term outcomes of total aortic root replacement (TARR) using mechanical valve grafts require evaluation.

Purpose of the Study:

• To assess the long-term results of TARR with mechanical valve grafts in selected patients.
• To evaluate survival rates, thromboembolic events, and bleeding events after TARR.

Main Methods:

• A retrospective review of 100 patients aged over 65 who underwent elective TARR with mechanical valve grafts between 1993 and 2003.
• Analysis of patient demographics, etiology of aortic root disease, concomitant procedures, hospital mortality, overall survival, and complication rates (embolic and bleeding events).

Main Results:

• Hospital mortality was 4%. Overall survival rates at 1, 5, and 7 years were 93.9%, 89.1%, and 83.2%, respectively.
• A high rate of thromboembolic events (10.3 per 100 patient-years) was observed, with actuarial embolism-free survival at 7 years of 74.3%.
• Bleeding events occurred at a rate of 2.2 per 100 patient-years, with actuarial bleeding-free survival at 7 years of 87.7%. No reoperations or valve dysfunctions were reported.

Conclusions:

• TARR using mechanical valve grafts provides excellent survival in carefully selected patients.
• A significant rate of minor thromboembolic events necessitates further investigation into management strategies.
• Combination therapy with aspirin and oral anticoagulants may warrant consideration to mitigate thromboembolic risk.