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Effect of Elective Bentall Procedure on Left Ventricular Systolic Function and Functional Status: Long-Term Follow-Up
Insights
The Bentall procedure significantly improved long-term heart function and patient quality of life. This study shows improved left ventricular systolic function and functional status in patients after elective aortic repair.
Area of Science:
- Cardiology
- Cardiac Surgery
- Thoracic Surgery
Background:
- Limited data exists on long-term outcomes of the Bentall procedure.
- The Bentall procedure corrects aortic valve disease and ascending aorta aneurysms.
Purpose of the Study:
- To evaluate long-term effects of the Bentall procedure on left ventricular systolic function and functional status.
- To assess survival rates and changes in cardiac metrics post-procedure.
Main Methods:
- Retrospective study of 90 consecutive patients undergoing the Bentall procedure (1997-2003).
- Mean follow-up of 117 months, monitoring mortality, left ventricular ejection fraction, volumes, and NYHA class.
- Echocardiography performed pre-procedure and at follow-up.
Main Results:
- No operative deaths; 73.3% survival rate during follow-up.
- Significant improvement in left ventricular ejection fraction (0.49 vs 0.41, P <0.0001).
- Significant reductions in end-systolic and end-diastolic volumes; 80.3% of patients improved NYHA class.
Conclusions:
- The Bentall procedure demonstrates significant long-term benefits for left ventricular systolic function.
- Improved functional status (NYHA class) observed in the majority of surviving patients.
- Elective Bentall procedure is associated with favorable long-term cardiac remodeling and functional recovery.
Abstract:
Because there are so few data on the long-term effects on left ventricular systolic function and functional status in patients who electively undergo Bentall procedures, we established a retrospective study group of 90 consecutive patients. This group consisted of 71 male and 19 female patients (mean age, 54 ± 10 yr) who had undergone the Bentall procedure to correct aortic valve disease and aneurysm of the ascending aorta, from 1997 through 2003 in a single tertiary-care center. We monitored these patients for a mean period of 117 ± 41 months for death, left ventricular ejection fraction and volume indices, and functional capacity as determined by New York Heart Association (NYHA) class. There were no operative deaths. The survival rate was 73.3% during follow-up. There were 10 cardiac and 13 noncardiac deaths, and 1 death of unknown cause. Echocardiography was performed before the index procedure and again after 117 ± 41 months. In surviving patients, statistically significant improvement in left ventricular ejection fraction, in comparison with preoperative values (0.49 ± 0.11 vs 0.41 ± 0.11; P <0.0001), was noted at follow-up. Similarly, we observed statistically significant reductions in left ventricular end-systolic (39.24 ± 28.7 vs 48.77 ± 28.62 mL/m(2)) and end-diastolic volumes (54.63 ± 6.97 vs 59.17 ± 8.92 mL/m(2); both P <0.0001). Most patients (53/66 [80.3%]) progressed from a higher to a lower NYHA class during the follow-up period. The Bentall procedure significantly improved long-term left ventricular systolic function and functional status in surviving patients who underwent operation on a nonemergency basis.
