Abstract/References

Objectives: To evaluate the early and late outcomes of the modified Bentall procedure with the flanged technique.

Methods: We reviewed the medical records of 63 patients who had undergone root replacement by the modified Bentall procedure at our institute between January 2001 and December 2018. In most cases, we adopted a composite graft constructed with a mechanical valve or bioprosthesis and a Dacron graft by the flanged technique. Since 2011, we have used Valsalva grafts.

Results: Mean age 57 ± 16 years, range 16-80, male 43 cases. The mean follow-up was 75 ± 56 months (range 0-216). Through April 1, 2020, we could follow up on 61 cases (97%) within a six-month period. Hospital mortality was 7.9% (4.8% in elective cases). In late follow-up, eight deaths were observed. In the bio-Bentall group (n=26), no deaths or major adverse valve-related events (MARVEs) occurred. In the mechanical Bentall group (n=37), seven cases of MARVEs, including two cerebral hemorrhages and one cerebral embolism, were observed. All patients were free from MARVEs at 5 years post procedure in the bio-Bentall group, and 93.8% and 76.8% were event-free at 5 years and 10 years, respectively, in the mechanical Bentall group.

Conclusions: The 18-year results of the modified Bentall procedure were acceptable, providing excellent outcomes in the bio-Bentall group. The flanged technique enabled the use of a larger prosthesis, which may have resulted in good durability with the bio-Bentall procedure.

1. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax, 23:338-339, 1968.

2. Mookhoek A, Korteland NM, Arabkhani B, et al. Bentall procedure:a systematic review and meta-analysis. Ann Thorac Surg, 101:1684-1689, 2016.

3. Castrovinci S, Tian DH, Murana G, et al. Aortic root replacement with biological valved conduits. Ann Thorac Surg, 100:337-353, 2015.

4. Urbanski PP, Heinz N, Zhan X, et al. Modified bio-Bentall procedure:10-year experience. Eur J Cardiothorac Surg, 37:1317-1321, 2010.

5. Di Marco L, Pacini D, Pantaleo A, et al. Composite valve graft implantation for the treatment of aortic valve and root disease:Results in 1045 patients. J Thorac Cardiovasc Surg,152:1041-1048.e1, 2016.

6. Lechiancole A, Celiento M, Isola M, et al. Modified Bentall procedure:mechanical vs biological valved conduits in patients older than 65 years. Int J Cardiol, 296:38-42, 2019.

7. Stefanelli G, Pirro F, Macchione A, et al. Long-term follow-up after Bentall operation using a stentless Shelhigh NR-2000 bio-conduit. J Card Surg, 35:988-995, 2020.

8. Katselis C, Samanidis G, Papasotiriou A, et al. Long-term results after modified Bentall operation in 200 patients. J Heart Valve Dis, 26:639-645, 2017.

9. Celiento M, Ravenni G, Margaryan R, et al. The modified Bentall procedure:a single-institution experience in 249 patients with a maximum follow up 21.5 years. J Heart Valve Dis, 25:448-455, 2016.

10. Dhurandhar V, Parikh R, Saxena A, et al. The aortic root replacement procedure:12-year experience from the Australian and New Zealand society of cardiac and thoracic surgeons database. Heart Lung Circ, 25:1245-1251, 2016

11. Yakut C. A new modified Bentall procedure:the flanged technique. Ann Thorac Surg, 71:2050-2052, 2001.

12. Akins CW, Miller DC, Turina MI, et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Ann Thorac Surg, 85:1490-1495, 2008.

13. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J, 38:2739-2791, 2017.

14. Baumgartner H Chair, Hung J Co-Chair, Bermejo J, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis:a focused update from the European association of cardiovascular imaging and the A merican society of echocardiography. Eur Heart J Cardiovasc Imaging, 18:254-275, 2017.

15. Bourguignon T, Bouquiaux-Stablo AL, Candolfi P, et al. Very long-term outcomes of the Carpentier-Edwards Perimount valve in aortic position. Ann Thorac Surg, 99:831-837, 2015.

16. Issa IF, Poulsen SH, Waziri F, et al. Structural valve deterioration in the Mitroflow biological heart valve prosthesis. Eur J Cardiothorac Surg, 53:136-142, 2018.

17. Johnston DR, Soltesz EG, Vakil N, et al. Long-term durability of bioprosthetic aortic valves: implications from 12,569 implants. Ann Thorac Surg, 99:1239-1247, 2015.

18. Minakata K, Tanaka S, Okawa Y, et al. Long-term outcome of the Carpentier-Edwards pericardial valve in the aortic position in Japanese patients. Circ J, 78:882-889, 2014.

19. Tabata M, Takayama H, Bowdish ME, et al. Modified Bentall operation with bioprosthetic valved conduit:Columbia University experience. Ann Thorac Surg, 87:1969-1970, 2009.

20. Chirichilli I, Irace FG, D’Aleo S, et al. Long-term follow-up of Bentall procedure using the perimount bioprosthesis and Valsalva graft. Interact Cardiovasc Thorac Surg, 30:679-684, 2020. doi:10.1093/icvts/ivaa007.

21. Bouhout I, Stevens LM, Mazine A, et al. Long-term outcomes after elective isolated mechanical aortic valve replacement in young adults. J Thorac Cardiovasc Surg, 148:1341-1346, 2014.

22. David TE. Aortic valve sparing in different aortic valve and aortic root conditions. J Am Coll Cardiol, 68:654-664, 2016.

23. Mazine A, El-Hamamsy I, Verma S, et al. Ross procedure in adults for cardiologists and cardiac surgeons. J Am Coll Cardiol, 72:2761-2777, 2018.

24. Sievers HH, Stierle U, Charitos EI, et al. A multicentre evaluation of the autograft procedure for young patients undergoing aortic valve replacement: update on the German Ross Registry. Eur J Cardiothorac Surg, 49:212-218, 2016.