Long-term survival and operative outcomes of the Bentall procedure for aortic root aneurysm, aortic dissection, and endocarditis.

Abstract

To assess outcomes after aortic root replacement with Bentall procedure for aortic aneurysm, dissection, and endocarditis. We identified consecutive patients undergoing Bentall procedures from 1997 to 2023, with stratification based on the primary diagnosis. Operative outcomes and long-term survival were compared. Of 1493 patients, 1378 (92.3%) underwent surgery for aneurysms, 75 (5%) for dissections, and 40 (2.7%) for endocarditis. The aneurysm group was older (61 years [range, 50-70 years] vs 57 years [range, 47-66.5 years] vs 56 years [range, 49-64 years]; P = .024). Patients with dissection or endocarditis had more preoperative myocardial infarctions (7.4% vs 12% vs 17.5%; P = .026), cerebrovascular accidents (9.6% vs 18.7% vs 45%; P < .001), renal dysfunction (8.3% vs 22.7% vs 45%; P < .001), shock (0.1% vs 10.7% vs 15%; P < .001), and ruptures (0.4% vs 10.7% vs 10%; P < .001). Regarding outcomes, acute renal failure (0.6% vs 1.3% vs 7.5%; P < .001) and operative mortality (0.4% vs 1.3% vs 7.5%; P = .001) were higher for endocarditis. Reexploration for bleeding was highest for dissections (4.1% vs 12% vs 2.5%; P = .004). Ten-year survival was similar between groups (71.8% vs 67% vs 83.7%; P = .94), with mean follow-up 68.2 ± 2.08 months. Multivariable analysis found age (hazard ratio [HR], 1.04; 95% CI, 1.03-1.05; P < .001), chronic obstructive pulmonary disease (HR, 2.12; 95% CI, 1.44-3.11; P < .001), renal dysfunction (HR, 1.97; 95% CI, 1.4-2.78; P < .001), and ejection fraction (HR, 0.97; 95% CI, 0.95-0.98; P < .001) were associated with late mortality but primary diagnosis was not. The Bentall procedure can be performed with low operative risk for aneurysms and selected dissections. Endocarditis is associated with higher but acceptable operative mortality. Excellent long-term survival can be expected after surviving initial operative risk.