ABSTRACT Background and aim of the study: To evaluate the long-term clinical outcomes of the modified Bentall procedure (MBP) with a mechanical conduit. Material and methods: Between 1993 and 2014, 249 patients with a mean age of 62±12 years (range, 25 to 87) underwent a MBP. The main indication was annuloaortic ectasia (102 patients, 41%) followed by acute aortic dissection (n=82, 33%); moderate to severe aortic regurgitation was present in 79% of cases. A bicuspid aortic valve was found in 17% and Marfan syndrome in 7%. Mean functional class (according to the New York Heart association classification) was 2.5±1.1. Concomitant procedures were performed in 36 patients (14%). Mean follow-up is 8.7±5.0 years (from 0.3 to 21.5 years) being 99% complete with a total follow-up of 6475 patient-years. Results: Operative mortality was 3% in elective cases. Age, prolonged cardiopulmonary bypass times and mechanical ventilation > 96 h, were independent risk factors for early mortality. Actuarial survival at 15 and 20 years is 62% and 60%. Risk factors for late mortality were age and emergency operation. Actuarial freedom from thromboembolism (linearized incidence 0.93 %/pt-yrs) is 82% at 15 years and 74% at 20 years. Seven patients required reoperation (0.38%/pt-yrs) with an actuarial freedom from reoperation of 91% at 15 years and 87% at 20 years. The incidence of overall valve-related complications is 0.32 %/pt-yrs with an actuarial freedom of 94% at 15 and 20 years. Conclusions: The MBP has shown excellent long-term results with a low incidence of procedure-related complications up to 20 years postoperatively. For this reason we consider it as a valid option to treat aortic root disease, whenever valve-sparing procedures are not indicated.
The modified Bentall procedure: single institution experience in 249 patients with a maximum follow-up of 21.5 years
BORTOLOTTI, UBERTO
2016-01-01
Abstract
ABSTRACT Background and aim of the study: To evaluate the long-term clinical outcomes of the modified Bentall procedure (MBP) with a mechanical conduit. Material and methods: Between 1993 and 2014, 249 patients with a mean age of 62±12 years (range, 25 to 87) underwent a MBP. The main indication was annuloaortic ectasia (102 patients, 41%) followed by acute aortic dissection (n=82, 33%); moderate to severe aortic regurgitation was present in 79% of cases. A bicuspid aortic valve was found in 17% and Marfan syndrome in 7%. Mean functional class (according to the New York Heart association classification) was 2.5±1.1. Concomitant procedures were performed in 36 patients (14%). Mean follow-up is 8.7±5.0 years (from 0.3 to 21.5 years) being 99% complete with a total follow-up of 6475 patient-years. Results: Operative mortality was 3% in elective cases. Age, prolonged cardiopulmonary bypass times and mechanical ventilation > 96 h, were independent risk factors for early mortality. Actuarial survival at 15 and 20 years is 62% and 60%. Risk factors for late mortality were age and emergency operation. Actuarial freedom from thromboembolism (linearized incidence 0.93 %/pt-yrs) is 82% at 15 years and 74% at 20 years. Seven patients required reoperation (0.38%/pt-yrs) with an actuarial freedom from reoperation of 91% at 15 years and 87% at 20 years. The incidence of overall valve-related complications is 0.32 %/pt-yrs with an actuarial freedom of 94% at 15 and 20 years. Conclusions: The MBP has shown excellent long-term results with a low incidence of procedure-related complications up to 20 years postoperatively. For this reason we consider it as a valid option to treat aortic root disease, whenever valve-sparing procedures are not indicated.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.