Mid- and Long-term evaluaton of an alternative to the modified Bentall procedure for Aortic Root aneurysm

Yong WangWeitie WangTonghua DuMaoxun HuangMixia LiKeyan LiuHulin PiaoZhicheng Zhutiance wangKexiang Liu^*

• Second Affiliated Hospital of Jilin University, Changchun, China

Background: Due to complications such as aortic root bleeding and high coronary tension with the conventional Bentall technique to treat aortic root aneurysms, new methods have been developed to enhance patient outcomes. This study aimed to describe a novel modification of the Bentall procedure for aortic root replacement and to report on its mid- and long-term follow-up outcomes. Methods: Patients diagnosed with aortic root aneurysm were enrolled in the study. The inclusion criteria included diameter of ascending aorta larger than 50 mm and the aortic valve with organic lesions. Data were collected including surgical time, aortic clamping time, cardiopulmonary bypass time, and pre-discharge computed tomography angiography findings. Results: Eighty-eight patients (nine with Marfan syndrome), including 69 men (78.4%) and 19 women (21.6%), underwent aortic root replacement using our new root reconstruction technique from 2011 to 2020 at our hospital. The patients’ mean age was 43.4 ± 11.7 years (range, 20–71 years). Of them, 35 (39.8%) had a Stanford type A aortic dissection (dissection group), while 53 (60.2%) had an aortic root aneurysm (aneurysm group). The patients’ in-hospital mortality rate was 2.3% (one case of multiple organ dysfunction syndrome, one case of arrhythmia). The mean aortic cross-clamp and cardiopulmonary bypass times were 120.9 ± 27.1 min and 159.2 ± 37.9 min, respectively. The follow-up rate was 94.2% (81/86) for a mean duration of 55 ± 23 months (range, 6–120 months). Follow-up mortality occurred in three cases (3.7%), including one death due to a traffic accident, one death due to cerebral hemorrhage, and one sudden death of unknown reasons. No patients required an aortic root re-operation during follow-up. The overall survival rate was 98.8%, 95.9%, and 95.9% after 48, 96, and 120 months, respectively. Conclusions: Our initial experience suggests that this technique is feasible and safe, with promising mid- and long-term outcomes in our series. These descriptive results justify further comparative studies to evaluate its role as a potential alternative for the treatment of aortic root aneurysms.