Modified Bentall operation - outcomes with emphasis on the aortic index

Analysis of the early results and long term outcome after the modified Bentall operation with a mechanical prosthesis in a single Institution, emphasizing the use of the aortic index in elective procedures to assist the difficult decision of replacing the ascending aorta in patients with aortic valve disease.

Prospective study of 126 consecutive patients operated in a 16 year period. In 82 patients (65%) the surgeries were performed electively but the remaining 44 patients were operated urgently for acute aortic dissection or acute bacterial endocarditis. Total follow-up time was 519.96 patient-years. Time related analyses, including freedom from event analysis, were calculated with the Product Limited Method of Kaplan and Meier and tested with the Log-Rank and Cox Regression tests.

Early mortality was 7.9% for the entire cohort. There was no mortality on elective primary operations. The aortic index was computed in 93% of the elective procedures, ranging between 1.9 and 6.9 cm2/ m2. For all patients, survival at 15 years was 67.3% and freedom from local complications requiring reoperation was 95.6 % at same time.

The modified Bentall operation can be performed with low mortality and morbidity in selected patients and an exceptionally low rate of local complications in the long term. The aortic index is a valuable tool to help cardiac surgeons to decide when to replace a dilated ascending aorta.