Long-term survival after the Bentall procedure in 206 patients with bicuspid aortic valve

The recognition that patients with a bicuspid aortic valve (BAV) are at risk for aorta-related death (rupture or dissection) has favored composite aortic root replacement in BAV patients who undergo aortic valve replacement for valve dysfunction as well as in asymptomatic BAV patients with significant aortic root dilatation. We report the results of Bentall operations in 206 BAV patients during an 18-year interval.

Two hundred six BAV patients (mean, 53 +/- 14 years, 84% male) underwent composite aortic root replacement between September 1987 and May 2005. One hundred nine patients (53%) presented with aortic regurgitation, 24 patients (12%) presented with aortic stenosis, and 55 patients (26%) presented with combined aortic stenosis and aortic regurgitation. Median preoperative aortic diameter was 5.5 cm (range, 3 to 9 cm). Twenty-two patients (11%) underwent urgent or emergent procedures; 11 had acute type A dissection (5%). Sixty-one percent had a mechanical valve Bentall prosthesis; in 39%, a biologic valve was implanted. Thirty-two percent had concomitant procedures.

Overall hospital mortality was 2.9% (n = 6), and stroke rate was 1.9% (n = 4). Risk factors for adverse outcome (death or stroke), which occurred in 4.8% (n = 10), were presence of clot or atheroma (p = 0.02) and age older than 65 years (p = 0.05). During a mean follow-up of 5.9 years (1,200 patient-years; range, 5 to 18 patient-years), no patient required ascending aortic reoperation. Long-term survival was 93% after 5 years and 89% after 10 years. Discharged patients enjoyed survival equivalent to a normal age- and sex-matched population and superior to survival reported for a series of patients with aortic valve replacement alone.

In patients with BAV, the Bentall procedure has an operative mortality no worse than that for aortic valve replacement, with superior long-term survival and a lower rate of aortic reoperation.