Modified Bentall procedure improves postoperative bleeding and medium-term survival

Abstract

Background: Bentall procedure is a standard technique for complete aortic root replacements but a huge challenge is postoperative bleeding. This study was to evaluate the perioperative and long-term outcomes of the self-assembled composite graft with cuff formation for the Bentall procedure.
 Methods: A retrospective study of all patients undergoing Bentall procedure with button technique was performed from 2000-2019. Group 1 included 40 patients with commercial composite graft and group 2 included 45 patients with self-assembled composite graft with cuff. Perioperative outcomes were blood loss, reoperation for bleeding, complications, and operative mortality. Long-term outcomes included overall and reoperation-free survival.
 Results: Preoperative characteristics were similar in both groups, except mean age was higher in group 2 (48.2 versus 36.8 years). Group 2 significantly reduced blood loss in the first six hours postoperatively (250 versus 370 ml, P <0.001) and the risk of reoperation for bleeding (4.5% versus 17.5%, P = 0.002). Other complications were balanced between groups. Overall surgical mortality was 3. Reoperation was 7 cases. Group 2 also significantly improve the overall and reoperation-free survival: 95% and 95% (group 2) versus 75% and 70% (group 1) at four years respectively.
 Conclusions: Self-assembled composite graft with cuff formation is safe and effective for Bentall procedure in the treatment of aortic root diseases with the reduction of bleeding and improvement of long-term survival. Further investigations are required to improve the feasibility and effectiveness of the procedure.