Bio-Bentall With Self-Assembled Composite Graft: An Update After Two Decades of Experience

Area of Science:

• Cardiovascular Surgery
• Biomaterials Science
• Prosthetic Valve Technology

Background:

• Aortic root replacement is a critical procedure for managing aortic root pathologies.
• Biological valve prostheses are commonly used but can degenerate over time.
• Self-assembled composite grafts offer a potential solution for managing degenerated prostheses.

Purpose of the Study:

• To evaluate the long-term outcomes of aortic root replacement using a self-assembled composite graft with a biological valve prosthesis.
• To assess the safety and efficacy of this technique for aortic root replacement.
• To determine the feasibility of reintervention on the biological valve prosthesis within the composite graft.

Main Methods:

• A retrospective analysis of 308 patients who underwent bio-Bentall procedures between 1998 and 2021.
• The study exclusively used a self-assembled composite graft with a biological valve prosthesis.
• Long-term survival, reintervention rates, and risk factors for mortality were analyzed.

Main Results:

• Early mortality was 4.9% overall, with 0% in chronic aneurysm cases.
• 15-year survival was 41.9% for all patients and 62.5% for those under 65.
• The cumulative risk of reintervention for prosthesis degeneration at 15 years was 7.7%; reinterventions were often limited to the valve prosthesis.

Conclusions:

• Aortic root replacement with a self-assembled biological valve composite graft is a safe procedure.
• This technique facilitates safe reintervention on the degenerated biological valve prosthesis.
• The approach is particularly recommended for younger patients due to the potential for future valve replacement.