Management of aortic root in type A dissection: Bentall approach

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Acute type A aortic dissection (ATAAD) presents a high-risk surgical challenge.
• The modified Bentall procedure is a complex intervention for ATAAD.
• Evaluating outcomes in high-risk ATAAD patients is crucial for surgical decision-making.

Purpose of the Study:

• To analyze the early outcomes of the modified Bentall procedure in high-risk ATAAD patients.
• To identify factors influencing in-hospital mortality after this procedure.

Main Methods:

• Retrospective analysis of 314 high-risk ATAAD patients undergoing modified Bentall procedure (1996-2018).
• Conduit types included mechanical composite (45%), bioprosthesis in graft (33%), and xeno-/homograft root (22%).
• Concomitant procedures and perioperative data were recorded.

Main Results:

• In-hospital mortality was 17%, attributed to low cardiac output, brain injury, multiorgan failure, and sepsis.
• Permanent neurologic deficit occurred in 22%, myocardial infarction in 6%, and low cardiac output syndrome in 15%.
• Predictors of mortality included critical preoperative state, coronary malperfusion, coronary artery disease, and prior cerebrovascular accident.

Conclusions:

• The modified Bentall operation can achieve good early results in high-risk ATAAD patients.
• Concomitant procedures are often necessary and impact outcomes.
• Risk stratification and management of complications are key to improving survival.