Long-term outcomes of left coronary artery reconstruction by Svensson's modification to the Bentall procedure versus...

We aimed to evaluate the long-term outcomes of long-interposed graft replacement of the left coronary artery (Svensson's modification) in the modified Bentall procedure compared with button reconstruction using propensity score matching analysis.

In total, 101 patients who underwent the modified Bentall procedure with Svensson's modification (S group, n = 54) or button coronary artery reconstruction (B group, n = 47) between 1992 and 2024 were included. In the first era, we routinely performed Svensson's modification; recently, the procedure was performed when mobilization of the left coronary artery was difficult.

The median age was relatively lower in the S group (63.0 [50.5-68.8] years) than in the B group (66.0 [56.5-1.83] years). There were no significant differences in in-hospital mortality between the two groups, with two deaths recorded in each group. Five and four patients in the S and B groups, respectively, required additional intraoperative and postoperative interventions for button-reconstructed coronary arteries. In the long-term, both groups had no additional interventions for the reconstructed coronary ostia. In the S group, overall survival rates were 78.2, 67.6, and 60.8% at 10, 15, and 20 years, respectively, and the reoperation rates were 14.2, 18.3, and 18.3% at 10, 15, and 20 years, respectively. Propensity score matching showed no significant differences in in-hospital mortality, overall survival, or reoperation rates between both groups.

Svensson's modification of the Bentall procedure provided good long-term outcomes, equivalent to those of button reconstruction; it may provide good outcomes in patients with difficult mobilization of the left coronary artery.