Bentall Procedure: A Long-term, Single Center Experience

Though the Bentall operation is widely performed worldwide, data on long-term outcomes and rates of proximal reintervention is lacking. This study describes 15-year outcomes from a single center focusing on the risk of proximal reintervention and comparing biological vs mechanical Bentall. Two thousand patients underwent Bentall procedure at our institution from October 1979 to May 2023. The bio-Bentall group included 874 patients (43.7%), the mechanical group 1126 (56.3%). Patients from the biological group were older (mean age biological group=68.3, SD=8.0 vs 53.6 years for mechanical group, SD=12.4, p<0.001). They presented a higher incidence of comorbidities and urgent or emergent surgery. Mechanical Bentall patients were more likely to have Marfan syndrome, bicuspid aortic valve (BAV) and previous cardiac surgery. In-hospital mortality showed no significant difference between groups (47 −4.18%- vs 52 −5.95%-, p=0.069). Patients with a biological prosthesis had lower survival rates at 10 and 15 years (57.8% and 28.6%, respectively, vs 69.5% and 56.1%, p<0.001) and a threefold risk of proximal redo at follow-up compared to mechanical Bentall (8.2% and 15.2% at 10 and 15 years vs 2.4% and 4.6%, respectively, HR=3.512) The risk of reintervention was higher in the biological group in each age group. In the overall sample, the risk declines with age until 55 years, then slowly increases. The Bentall operation provides satisfactory long-term outcomes. Patients treated with a bio-Bentall showed a worse survival and freedom from proximal reintervention, even in the same age-group as mechanical Bentall. However, reintervention rates in the biological group are still acceptable.