In aortic root surgery, Bentall procedure has been considered the procedure of choice. Valve sparing root-replacement (VSRR) techniques have gained popularity, avoiding prosthetis-related complications. However, long-term data to support this tendency are still lacking, and most of the studies included emergency procedures, that could influence the outcome.
The primary end-point was survival. Secondary end-point was freedom from Major Adverse Events (MAEs), including death, aortic-valve reoperation, major haemorrhage, cerebrovascular events, aortic valve regurgitation (or dysfunction)>moderate.
Data of patients who underwent Bentall operation and VSRR from 1990 to 2017 in our centre were analysed. Emergency operations were excluded. Aortic valve stenosis were excluded from Bentall group.
130 patients underwent Bentall operation (29 biological and 101 mechanical conduits). 98 patients underwent elective VSRR (64 reimplantation and 34 remodeling techniques). Among baseline and operative data, in Bentall group were more bicuspid valves p < 0.001, previous cardiac operations p = 0.04, lesser preoperative AF p = 0.05 and mean X-clamp time p = 0.001. Mean follow up duration was 158 and 76 months in Bentall and VSRR groups.
Univariate analysis for long-term mortality: Age (HR 1.07, 95%IC 1.04–1.11)
Univariate analysis for MAEs: Age (HR1.05, 95%IC 1.02–1.07), VSRR (HR 1.8, 95%IC 1.09–3.11)
Multivariate analysis for MAEs: Age (HR 1.04, 95%IC 1.02–1.07), VSRR (HR 1.7, 95%IC 1.016–2.91)
Comparable long-term survival after Bentall operation and VSRR. Bentall operation seemed to offer better protection against MAEs than VSRR. VSRR procedures are technically demanding, and necessitate of a longer learning curve than the easily reproducible Bentall operation.