Long-term Outcomes of Stentless Bio-bentall vs. David Reimplantation for Aortic Root Dilatation and Aortic Valve Pathology

Abstract

Objective: To compare the early and mid-term clinical outcomes of patients undergoing two different surgical procedures (Bio-Bentall vs. David) for aortic root dilatation isolated or in association with aortic valve pathology. Methods: A population of 108 patients underwent aortic root replacement from 2004 to 2015 at our unit. Mean age at operation was 63 ± 99.9 years. The patients were retrospectively assigned to two groups, according to surgical procedure. David Reimplantation Operation was carried out in 52 patients (Group A), Stentless Biological Bentall in 56 patients (Group B). Pre-operative characteristics were similar in the two cohorts except for age and Euroscore. Mean follow-up time was 7.09 years (0.26-14.50 years) and it was 100% complete. Patients were evaluated and analyzed for perioperative results and long-term clinical outcomes. Results: Perioperative mortality was 0% in group A, 3.64% in group B (p = 0.26). Overall survival probability at 11 years was 91.8% in group A, 74.9% in group B (p = 0.0057). Cardiac mortality at 11 years was similar in the two groups (p = 0.129). Incidence of structural valve deterioration at 11 years was 88.8% in group A and 91.6% in group B (p = 0.776). Rate of reoperation at 11 years did not differ between the groups (88% in group A vs 97.9% in group B - p = 0.851). Occurrence of MACCE at 11 years was 76.7% in group A, 81.3% in group B (p = 0.634%). Mean gradient at last follow-up was lower in group A (8.13 mmHg vs. 11.70 mmHg - p < 0.001) Conclusions: David and Bio-Bentall procedures achieve excellent and comparable results at intermediate-time follow-up. David operation provides superior hemodynamic performances preserved over time, and maybe preferred in younger, active patients.