Bio-Bentall procedure versus isolated biological aortic valve replacement: a case-match study

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Cardiac Valve Surgery

Background:

• Aortic root replacement with composite grafts is a complex procedure.
• Isolated aortic valve replacement is a more common intervention.
• Comparing the risks of these two procedures is crucial for clinical decision-making.

Purpose of the Study:

• To evaluate the early and late postoperative risks of complete aortic root replacement using a composite graft with a biological valve prosthesis.
• To compare these risks with those of isolated aortic valve replacement using a biological valve prosthesis.

Main Methods:

• A retrospective study comparing 182 patients undergoing complete aortic root and ascending aorta replacement (modified Bentall procedure) with 1959 patients undergoing isolated aortic valve replacement.
• Patient matching based on sex, age, aortic valve defect, concomitant coronary surgery, and year of surgery identified 79 matched pairs.
• Follow-up data were collected for all patients.

Main Results:

• No significant difference in early postoperative mortality (30-day/in-hospital) between the root replacement group (5.1%) and the valve replacement group (3.8%).
• Long-term follow-up (mean 6.2 years) showed identical linearized death rates (4.66%/year vs. 4.71%/year) and similar 10-year actuarial survival (63.2% vs. 58.5%).
• Valve-related morbidities were comparable, with a trend towards lower rates of cerebral embolism in the aortic root replacement group.

Conclusions:

• Complete aortic root replacement with a biological composite graft, when performed by experienced surgeons, carries an operative risk comparable to isolated biological aortic valve replacement.
• Both procedures yield similar long-term survival rates.
• Valve-related event rates are comparable, with a potential benefit of reduced cerebral embolism after aortic root replacement.