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Association between left ventricular ejection fraction and mortality after Bentall procedure.

Masahiko Ando1, Haruo Yamauchi2, Takayuki Gyoten2

  • 1Department of Cardiac Surgery, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655, Japan. masandoo@gmail.com.

Heart and Vessels
|February 6, 2022
PubMed
Summary

The Bentall procedure for aortic root issues is risky with low left ventricular ejection fraction (LVEF). However, even patients with reduced LVEF can achieve long-term survival, necessitating careful surgical risk assessment.

Keywords:
AneurysmAortic rootOutcomeSurgery

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Aortic Root Surgery

Background:

  • Bentall procedure is crucial for aortic root pathology, often with low left ventricular ejection fraction (LVEF).
  • Preoperative LVEF significantly impacts surgical decision-making in elective Bentall procedures for aneurysms.

Purpose of the Study:

  • To investigate the association between preoperative left ventricular ejection fraction (LVEF) and patient outcomes following the Bentall procedure.
  • To assess the impact of varying degrees of reduced LVEF on survival and major adverse cardiovascular events (MACE) after Bentall surgery.

Main Methods:

  • Retrospective analysis of 98 patients undergoing Bentall procedure between April 2000 and March 2020.
  • Patients stratified into three groups based on preoperative LVEF: ≥60%, 45-60%, and <45%.
  • Comparison of baseline characteristics, survival rates, MACE, and cubic spline analysis for non-linear LVEF-mortality relationships.

Main Results:

  • Operative mortality and MACE were highest in the lowest LVEF group (<45%).
  • Despite worse outcomes, 10-year survival reached 40% in the lowest LVEF group.
  • LVEF was identified as an independent risk factor for mortality, with a potential non-linear association.

Conclusions:

  • Low preoperative LVEF is an independent predictor of mortality after Bentall procedure.
  • Long-term survival is achievable in select low LVEF patients, warranting careful risk-benefit analysis for elective cases.
  • Urgent Bentall procedures should be performed as indicated, irrespective of low LVEF.