Management of aortic root in type A dissection: Bentall approach

Abstract

Background We analyzed the results of the modified Bentall procedure in a high‐risk group of patients presenting with acute type A aortic dissection (ATAAD). Methods ATAAD patients undergoing a modified Bentall between 1996 and 2018 (n = 314) were analyzed. Mechanical composite conduits were used in 45%, and biological ones using either a bioprosthesis implanted into an aortic graft (33%) or xeno‐/homograft root conduits (22%) in the rest. Preoperative malperfusion was present in 34% of patients and cardiopulmonary resuscitation required in 9%. Results Concomitant arch procedures consisted of hemiarch in 56% and total arch/elephant trunk in 34%, while concomitant coronary artery surgery was required in 20%. The average cross‐clamp and cardiopulmonary bypass times were 126 ± 43 and 210 ± 76 min, respectively, while the average circulatory arrest times were 29 ± 17 min. A total of 69 patients (22%) suffered permanent neurologic deficit, while myocardial infarction occurred in 18 cases (6%) and low cardiac output syndrome in 47 (15%). The in‐hospital mortality rate was 17% due to intractable low cardiac output syndrome (n = 29), major brain injury (n = 16), multiorgan failure (n = 6), and sepsis (n = 2). The independent predictors of in‐hospital mortality were critical preoperative state (odds ratio [OR], 5.6; p < .001), coronary malperfusion (OR, 3.6; p = .002), coronary artery disease (OR, 2.6; p = .033), and prior cerebrovascular accident (OR, 5.6; p = .002). Conclusions The modified Bentall operation, along with necessary concomitant procedures, can be performed with good early results in high‐risk ATAAD patients presenting.

Aortic root replacement in bicuspid versus tricuspid aortic valve patients

“…According to patient’s age and risk profile, standard biological prostheses sewn into a tubular dacron prostheses, xeno- or homograft root prostheses, or commercially available mechanically-valved conduits were used for root replacement. The modified Bentall procedure, routinely utilized at our institution, was just recently described by Khachatryan et al ( 10 ).…”

Acute Aortic Syndromes from Diagnosis to Treatment—A Comprehensive Review

“…A supracoronary tube graft, with or without valve replacement or repair, may be adequate to accomplish this purpose provided the aortic root is unaffected. The standard procedure for treating aortic root inclusion is a Bentall–De Bono operation, which can be combined with a mechanical or biological valve replacement [ 61 , 62 ].…”

Research Progress on Aortic Root Aneurysms

“…Additionally, contrary to the recommendations for mitral valves, aortic valve-related diseases still rely on valve replacement as the first-line treatment. Therefore, for patients with aortic root aneurysm or aortic dissection involving the aortic root accompanied by aortic valve dysfunction, the aortic valve combined with Dacron artificial vascular replacement and coronary artery transplantation are still the most common surgical treatment methods [ 35 , 36 ]. However, according to the Carpentier functional classification, for patients with noncalcified bicuspid malformations and valve changes with normal leaflets, there has been an increasing trend of valve repair or valve preservation surgery for patients with type I (normal valve movement), II (leaflet prolapse), or IIIb (limited leaflet closure only).…”