Comparison of the Bentall procedure versus valve-sparing aortic root replacement

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Bentall and valve-sparing root replacement (VSRR) are standard treatments for aortic root disease.
• Patient demographics and surgical history significantly influence procedure selection and outcomes.

Purpose of the Study:

• To compare the clinical outcomes of bioprosthetic Bentall (BB), mechanical Bentall (MB), and VSRR procedures.
• To evaluate survival rates and freedom from adverse events including aortic insufficiency, reoperation, and death.

Main Methods:

• A single-center retrospective analysis of 170 patients undergoing BB, MB, or VSRR between November 2007 and October 2016.
• Survival analysis was conducted to assess a composite endpoint of recurrent aortic insufficiency, reoperation, or death.
• Patient data including age, prior cardiac surgeries, cardiopulmonary bypass time, and cross-clamp time were analyzed.

Main Results:

• VSRR patients were younger on average (49.2 years) compared to BB (63.8 years) and MB (45.5 years) groups, though MB patients had a higher rate of prior cardiac surgeries (50.8%).
• VSRR procedures involved significantly longer cardiopulmonary bypass (P=0.04) and cross-clamp times (P=0.0005).
• Despite longer operative times, VSRR demonstrated superior combined freedom from death and reoperation compared to BB and MB procedures.

Conclusions:

• Valve-sparing root replacement (VSRR) is associated with improved survival outcomes in experienced centers, offering an alternative to Bentall procedures.
• Bentall procedures remain an excellent option, particularly for patients with more severe or emergent aortic root disease who may not be candidates for VSRR.
• VSRR, when performed in experienced centers, shows comparable morbidity and mortality with enhanced survival benefits for aortic root disease management.