Reduction of aorta-related deaths with the bentall procedure in patients with bicuspid aortic valve

Objectives: The recognition that patients with a bicuspid aortic valve (BAV) are at risk for aorta-related death (aneurysm/dissection) has favored the concept of composite aortic root replacement in BAV patients who undergo aortic valve replacement for valve dysfunction, and elective Bentall procedures in BAV patients with even modest aortic root dilatation. We report the results of Bentall operations in 206 patients with BAV over an 18-year interval.

Methods: 206 patients with BAV (53±14years, 84% male) and an aortic diameter at the time of operation of 5.6±0.9cm underwent composite aortic root replacement between 9/87 and 5/05. 155 patients (75.2%) presented with aortic regurgitation. 126 patients (61.2%) had a mechanical Bentall prosthesis; a biological valve was utilized in 80 patients (38.8%). 79 patients (38.3%) underwent concomitant proximal (N=75) or mid/distal (N=4) arch replacement. Perfusion time was 232±56min. Twenty-two patients (11%) underwent urgent/emergent procedures; 11 patients (5.4%) had acute type-A dissection.

Results: Overall operative mortality was 2.4%. The causes of operative death were low output (1), late tamponade (1) and endocarditis (3). No deaths occurred following emergency procedures. The ICU-stay was 2.8±2 and the hospital stay 11±11days, in average. During a mean follow-up of 3.5 years (range 5–18), no patient required reoperation. One patient with untreated hypertension suffered distal ascending aortic rupture 4 years postoperatively.

Conclusion: These results – 6 deaths in 700 patient-years of follow-up – suggest that the Bentall procedure may yield a better outcome than would occur in BAV patients without operation unless the yearly risk of aorta-related death (rupture/dissection) is less than 1%.