Repair of aortic root in patients with aneurysm or dissection: comparing the outcomes of valve-sparing root replacement with those from the Bentall procedure

Introduction

Management of aortic root aneurysm or dissection has been the subject of muchdiscussion that has led to some modifications. The current trend is avalve-sparing root replacement. We compared the outcome following valve sparingroot repair with Bentall procedure.

Methods

We retrospectively evaluated 70 patients who underwent root replacement foraneurysm or dissection and compared the outcomes of valve-sparing root replacementwith those of the Bentall procedure from January 2007 to December 2011 at ourinstitution.

Results

Twenty-five patients had valve-sparing aortic root replacement (VSR, includingreimplantation or remodeling) (23 males and 2 females), and 45 patients had theBentall procedure (34 males and 11 females). Patients who underwent a VSR wereyounger with a mean age of 55.4 ± 14.8 years compared to those who underwent theBentall procedure with a mean age of 60.6 ± 12.7 (P=ns). Thepreoperative aortic insufficiency (AI) in the VSR group was moderate in 8 (32%)patients, and severe in 6 (24%). Preoperative creatinine was 1 ± 0.35 mg/dl in theVSR group and 1.1 ± 0.87 mg/dl in the Bentall group. In the VSR group, 3 (12%)patients had emergency surgery; by contrast, in the Bentall group, 8 (17%)patients had emergent surgery. Concomitant coronary artery bypass grafting(excluding coronary reimplantation) was performed in 8 (32%) patients in the VSRgroup and in 12 (26.6%) patients in the Bentall group (P=0.78);additional valve procedures were performed in 2 (8%) patients in the VSR group andin 11 (24.4%) patients in the Bentall group. The perioperative mortality was 8%(n=2) and 13.3% (n=6), for the VSR and Bentall procedures, respectively(P=0.7, ns). The total duration of intensive care unit staywas 116.6 ± 106 hours for VSR patients and 152.5 ± 218.2 hours for Bentallpatients (P=0.5). The overall length of stay in the hospital was10 ± 8.1 days for VSR and 11 ± 9.52 days for Bentall (P=0.89).The one-year survival was 92% for the VSR group and 79.0% for the Bentall group.The seven-year survival for the VSR group was 92% and 79% for the Bentall group(95% CI [1.215 to 0.1275], P=0.1).

Conclusion

Aortic valve-sparing root replacement can be performed with acceptable morbidityand mortality with a comparable long-term survival to the Bentall procedure.