Mechanical Versus Biological Bentall Procedure: A Propensity-Score Matching Analysis of 548 Consecutive Patients

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• The Bentall procedure is the standard for ascending aorta/aortic root aneurysms with aortic valve disease.
• Valve-sparing procedures are not feasible in these complex cases.

Purpose of the Study:

• To compare early and late outcomes of the Bentall procedure using biological versus mechanical valved conduits.
• To evaluate mortality and reintervention rates between the two conduit types.

Main Methods:

• Retrospective review of 548 patients undergoing Bentall procedure (2001-2022).
• Propensity-score (PS) matching created two homogeneous groups of 154 patients.
• Clinical outcomes analyzed included mortality and reintervention rates.

Main Results:

• No significant difference in mean survival time between mechanical and biological Bentall groups (16 ± 0.8 vs. 16.3 ± 0.7 years, p=0.72).
• Mechanical Bentall group showed significantly longer survival free from reintervention (23.6 ± 0.4 vs. 21.4 ± 0.7 years, p=0.02).
• Age >65, postoperative ECMO, and CVA were identified as mortality risk factors.

Conclusions:

• The Bentall operation is a safe and effective treatment for ascending aorta and aortic root disease.
• PS-matched analysis revealed no difference in mortality between mechanical and biological Bentall conduits.
• Mechanical Bentall conduits were associated with a lower rate of reintervention compared to biological conduits.