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Related Experiment Videos

Three faces of the Bentall procedure

P S Midulla1, A Ergin, J Galla

  • 1Department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York 10029.

Journal of Cardiac Surgery
|September 1, 1994
PubMed
Summary

The Button Bentall technique is the preferred method for aortic valve and ascending aorta replacement, showing comparable reoperation rates and good survival. The Cabrol technique had poorer outcomes, likely due to patient selection.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Surgery

Background:

  • The Bentall procedure, for composite aortic valve and ascending aorta replacement, has undergone several modifications since its inception in 1968.
  • Evaluating the comparative outcomes of these different anastomotic techniques is crucial for optimizing patient care.

Purpose of the Study:

  • To retrospectively review and compare the results of three different anastomotic techniques used in the Bentall operation: Classic, Button, and Cabrol.
  • To identify risk factors associated with hospital mortality and long-term outcomes after the Bentall procedure.

Main Methods:

  • Retrospective review of 140 consecutive patients undergoing Bentall operations between October 1986 and March 1994.
  • Analysis of three anastomotic techniques: Classic (n=30), Button (n=95), and Cabrol (n=15).

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  • Assessment of hospital mortality, reoperation rates, survival, and aortic valve-related complications.

    • Main Results:

    • Overall hospital mortality was 5%. Univariate analysis suggested associations between mortality and acute type A dissection, rupture, preoperative neurological symptoms, and the Cabrol technique, but these were not independent risk factors in multivariate analysis.
    • Reoperation rates did not significantly differ among the techniques (Classic 4.1%/pt-yr, Button 2.7%/pt-yr, Cabrol 0%/pt-yr; p=0.44), with 5-year freedom from reoperation at 87%.
    • Five-year actuarial survival was 79% overall (Classic 85%, Button 82%, Cabrol 52%), with poorer results in the Cabrol group attributed to patient selection and higher early mortality. Dissection was linked to higher mortality in Marfan patients (50% vs 8%, p=0.03).

    Conclusions:

    • The Button Bentall technique is recommended as the routine procedure of choice for aortic valve and ascending aorta replacement.
    • The Classic and Cabrol variations should be reserved for specific circumstances.
    • Current indications for elective Bentall procedures include specific ascending aortic diameters with valvular dysfunction or in patients with Marfan syndrome or bicuspid aortic valves.