Yonsei Med J.  2012 Sep;53(5):915-923.

Clinical Experience with the Bentall Procedure: 28 Years

• Joo HC
• Chang BC
• Youn YN
• Yoo KJ
• Lee S

Abstract

PURPOSE
We retrospectively analyzed 28 years of experience with the Bentall procedure in patients with aortic valve, aortic root, and ascending aortic disease.
MATERIALS AND METHODS
Between March 1982 and December 2010, a total of 218 patients underwent the Bentall procedure using a composite valved conduit. The "inclusion technique" was used in 30 patients (13.8%), the "open-button technique" in 181 patients (83.0%), and the Cabrol technique in 7 patients (3.2%).
RESULTS
The early mortality rate was 5.5% (12/218). The mean follow-up duration was 108.0+/-81.0 months (range: 1-329 months). Seven patients required re-operation, and 1 patient required stent graft insertion at the descending thoracic aorta for progression of aortic arch or descending thoracic aortic dissection or aneurysm after the first operation, and 5 of them had Marfan syndrome. Kaplan-Meier estimated survival rates at 1, 5, 10, 20, and 25 years were 90.4%, 82.7%, 77.6%, 65.3%, and 60.3%, respectively. Freedom from reoperation rates at 1, 5, 10, 20, and 25 years were 99.0%, 98.3%, 95.5%, 90.8%, and 90.8%, respectively.
CONCLUSION
In our experience, the Bentall procedure provided optimal survival with improved functional status. The disease of the aorta may progress, especially in patients with Marfan syndrome. Therefore, careful follow-up with regular computed tomography angiograms should be performed in these patients.

Keyword

Annuloaortic ectasia; marfan syndrome; bentall procedure

MeSH Terms

Aneurysm
Aorta
Aorta, Thoracic
Aortic Diseases
Aortic Valve
Blood Vessel Prosthesis
Follow-Up Studies
Freedom
Humans
Marfan Syndrome
Mortality
Reoperation
Retrospective Studies
Survival Rate

Figure

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  Fig. 1 Kaplan-Meier estimated survival curves. Actual survival of all patients, at a mean follow-up time of 108.0±81.0 months, following the Bentall procedure (A). Actual survival of Marfan and non-Marfan syndrome patients (B).

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  Fig. 2 Kaplan-Meier estimated survival curves. Actual survival rate for non-dissection and dissection patients (A). Actual survival of non-dissection (group 1), acute dissection (group 2) and chronic dissection (group 3) patients (B).

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  Fig. 3 Kaplan-Meier estimated survival curves. Actual survival rate according to coronary transfer technique. Inclusion (group 1), open-button (group 2), Cabrol (group 3).

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  Fig. 4 Kaplan-Meier estimated freedom from reoperation. Freedom from reoperation for all patients, at a mean follow-up time of 100 months, following the Bentall procedure (A). Freedom from reoperation for Marfan versus non-Marfan syndrome patients (B).

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  Fig. 5 Kaplan-Meier estimated freedom from prosthetic valve related complications. Kaplan-Meier estimated freedom from anti-coagulation-related complications (A), endocarditis-related complications (B), and valve-related complications (C).

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