Twenty-five-year single-center experience with aortic root replacement with a composite valve graft

The study objective was to evaluate the in-hospital and long-term outcomes of aortic root replacement (Bentall procedure) from a single institution.

All patients who underwent the Bentall procedure from 1990 to 2014 were included. Aortic valve-sparing root replacement or Ross procedures were excluded. The primary end point was all-cause mortality. The secondary end point was major adverse valve-related events, a composite of death, aortic valve reoperation (surgical or transcatheter), aortic valve endocarditis, major bleeding, and the need for a permanent pacemaker or defibrillator.

A total of 1332 adults underwent a Bentall procedure during the study period, with 525 (39.4%) undergoing concomitant procedures and 807 (60.6%) undergoing the isolated Bentall. Mean age was 57.6 ± 15.6 years, with 130 patients (9.8%) having endocarditis and 400 patients (30.0%) having a previous cardiac surgery. Isolated aortic insufficiency was present in 600 patients (45%), and a mechanical valve was used in 516 of 1332 patients (38.7%). In-hospital or 30-day death occurred in 65 of 1332 patients (4.9%), which was worse among those undergoing concomitant valve or coronary bypass, 45 of 525 (8.6%) versus 20 of 807 (2.5%) in patients undergoing the isolated Bentall (P < .01). Patients undergoing an elective, first-time isolated Bentall (471 cases) had less than 1% mortality and stroke rates. Overall, 25-year survival was 33.8% (95% CI, 29.9-37.8), worse among those undergoing concomitant procedures (hazard ratio, 2.14; 95% CI, 1.83-2.50). Late survival after an isolated Bentall was worse than in the age- and sex-matched general population (hazard ratio, 1.49; 95% CI, 1.33-1.68).

Bentall procedures are associated with excellent short-term outcomes in a complex population with a large number of previous operations, endocarditis, and concomitant procedures. Long-term survival is worse than in age- and sex-matched controls, particularly among younger patients.