Modified bio-Bentall procedure: 10-year experience

Abstract

Objective: Biological aortic valve conduits are rarely used because of the concern that possible structural valve deterioration would require complete conduit replacement in a technically demanding operation. The aim of the study was to evaluate the 10-year experience with complete aortic-root replacement using a modified composite graft in which biological valve prosthesis was located inside the vascular graft allowing its replacement within the tube and leaving the coronary ostia untouched.

Methods: Self-assembled composite grafts as described have been used in our clinic since 1998 as the standard for patients needing a biological aortic-root replacement. Until December 2008, they were implanted in 182 consecutive patients with a mean age of 70 + or - 8 years. Indications for root surgery were chronic aneurysm, porcelain aorta, acute dissection, acute endocarditis and intra-operative root injury in 168, five, three, three and three patients, respectively. All perioperative data were collected prospectively.

Results: The technique performed ensured a significant valve oversizing in 30 patients with an annulus equal to or smaller than 23 mm (22.0 + or - 1.3mm) for whom the mean valve prosthesis size of 26.3 + or - 2.4mm was used. Rethoracotomy due to bleeding was necessary in eight patients (4.4%). No blood transfusion during the entire hospital stay was required for 69 patients (37.9%). The overall patient survival, including 30-day mortality of 0.5%, was 74.2% at the mean follow-up of 4 + or - 2.7 years. The linearised death rate was 6.5%year(-1) and was similar for that of the general age- and sex-matched control populations. Re-operation for valve deterioration occurred in one patient and was performed easily by valve replacement within the graft.

Conclusions: Aortic composite graft with biological valve prosthesis located inside the tube offers the possibility of considerable valve oversizing, excellent haemostatic characteristics and simple replacement of the valve prosthesis in case of its deterioration and can therefore be recommended for younger patients.