Influence of Bentall Procedure on Left Ventricular Function.

Ufuk Yildirim,Serkan Burç Deşer,Mustafa Kemal Demirag,Semih Murat Yucel,Fersat Kolbakir,Merve Polat,Hasan Tahsin Keceligil,Murat Muzaffer Güçlü

doi:10.21470/1678-9741-2019-0147

Abstract

ObjectiveTo evaluate the influence of Bentall procedure on left ventricular function and condition on long-term follow-up.MethodsSeventy-three consecutive patients who underwent an aortic root and ascending aorta replacement with composite valve button Bentall or flanged Bentall technique, from January 2007 to November 2018, were included in this retrospective study.ResultsPostoperative left ventricular ejection fraction significantly increased (52.14±11.38 vs. 56.79±11.36; P=0.041), left ventricular end-systolic diameter significantly reduced (38.25±9.31 mm vs. 34.17±9.15 mm; P=0.027), left ventricular end-diastolic diameter significantly reduced (56.42±9.72 mm vs. 51.58±9.03 mm; P=0.01), and left atrial diameter significantly reduced (45.33±12.77 mm vs. 39.25±12.41 mm; P=0.01), compared to preoperative values. Our long-term survival results are comparable with previous studies in which survival rates in 5 years and 10 years were 83.5% and 69.8%, respectively. In comparing patients according to their New York Heart Association (NYHA) functional class, it was shown that their postoperative functional capacity was improved during the follow-up period (2.1±0.56 vs. 1.2±0.42; P=0.001).ConclusionThe Bentall procedure significantly improved the left ventricular systolic function and condition and decreased the left ventricular end-systolic and end-diastolic diameters and the left atrial diameter on long-term follow-up, based on the transthoracic echocardiography. Bentall procedure can be performed with acceptable mortality and morbidity rates on long-term follow-up.

Highlights

The yearly incidence of mediastinal and thoracic aortic aneurysm is estimated to be about 4.5/100.000 in total population and 60% of them are related to the aortic root and ascending aortic aneurysm[1]
In comparing patients according to their New York Heart Association (NYHA) functional class, it was shown that their postoperative functional capacity was improved during the follow-up period (2.1±0.56 vs. 1.2±0.42; P=0.001)
Bentall procedure can be performed with acceptable mortality and morbidity rates on long-term follow-up

Summary

Introduction

The yearly incidence of mediastinal and thoracic aortic aneurysm is estimated to be about 4.5/100.000 in total population and 60% of them are related to the aortic root and ascending aortic aneurysm[1]. Aortic root and valve replacement with a composite graft with a mechanical valve and coronary artery reimplantation were first described in 1968 by Bentall and de Bono[3]. Bentall procedure has been the treatment of choice for aortic root with or without ascending aorta aneurysms, which improves clinics and hemodynamics of patients[3]. David reimplantation[5] and Sarsam and Yacoub remodeling techniques have been described as alternative valve sparing techniques[6]. Several modifications, such as button or flanged Bentall, were evolved to reduce bleeding, reduce coronary button tension, avoid kinking of coronary arteries, and reduce the time of surgery[3,7].

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Discussion

Conclusion