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Hamandi M, Nwafor CI, Baxter R, Shinn K, Wooley J, Vasudevan A, Harrington K, Schaffer J, Moore D, DiMaio JM, Ryan WH, Brinkman WT. Comparison of the Bentall procedure versus valve-sparing aortic root replacement. Proc (Bayl Univ Med Cent) 2020; 33:524-528. [PMID: 33100520 DOI: 10.1080/08998280.2020.1771163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Bentall and valve-sparing root replacement (VSRR) procedures are established treatments for aortic root disease. We present a single-center retrospective analysis comparing outcomes of bioprosthetic Bentall (BB), mechanical Bentall (MB), and VSRR patients from November 2007 to October 2016. Survival analysis was performed to evaluate the composite endpoint of freedom from recurrent aortic insufficiency, reoperation, or death. Of the 170 patients, BB was performed in 36 patients, MB in 63 patients, and VSRR in 71 patients. For BB, MB, and VSRR, the mean age was 63.8, 45.5, and 49.2 years (P < 0.001), respectively. Additionally, significantly more patients in the MB group (n = 32, 50.8%, P < 0.001) than in the BB and VSRR groups had prior cardiac surgeries. Cardiopulmonary bypass time and cross-clamp time were significantly longer in the VSRR group (P = 0.04 and 0.0005, respectively). Despite the complexity of the procedure, VSRR patients had higher combined freedom from death and reoperation than patients in the BB or MB groups. Elective Bentall root replacement is an excellent option for patients with root disease. Patients undergoing Bentall tend to have more severe or emergent cases, making them unlikely candidates for VSRR. VSRR in experienced centers carries equivalent morbidity and mortality and improved survival.
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Affiliation(s)
- Mohanad Hamandi
- Cardiovascular Research, Baylor Scott & White Research Institute, Plano, Texas
| | - C Ikenna Nwafor
- Cardiovascular Research, Baylor Scott & White Research Institute, Plano, Texas
| | - Ronald Baxter
- Cardiovascular Research, Baylor Scott & White Research Institute, Plano, Texas
| | - Kathryn Shinn
- Cardiovascular Research, Baylor Scott & White Research Institute, Plano, Texas
| | - Jordan Wooley
- Cardiovascular Research, Baylor Scott & White Research Institute, Plano, Texas
| | - Anupama Vasudevan
- Cardiovascular Research, Baylor Scott & White Research Institute, Plano, Texas
| | - Katherine Harrington
- Department of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, Texas
| | - Justin Schaffer
- Department of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, Texas
| | - David Moore
- Department of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, Texas
| | - J Michael DiMaio
- Department of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, Texas
| | - William H Ryan
- Department of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, Texas
| | - William T Brinkman
- Department of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, Texas
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Bori Bata AK, D'Ostrevy N, Pereira B, Geoffroy E, Dauphin N, Eljezi V, Azarnoush K, Ulman L, Camilleri L. Valve-sparing aortic root replacement-midterm outcomes and quality of life. Cardiovasc Diagn Ther 2017; 7:572-580. [PMID: 29302462 DOI: 10.21037/cdt.2017.08.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study evaluated the midterm outcomes, the valve related events and quality of life of patients treated by valve-sparing aortic root replacement (VSRR). Methods From January 2003 to December 2014, 88 consecutive patients diagnosed with an aortic root aneurysm or ascending aortic aneurysms underwent VSRR surgery. The mean age was 55±14 (range 19-77) years. A total of 84% of the patients were male; 89% were in New York Heart Association functional class I or II, 55% had aortic regurgitation (AR) grade III or IV. Twenty-four patients (27.3%) had bicuspid aortic valve. The mean left ventricular ejection fraction (LVEF) was 61%±9% (range 29-78%). Patients were yearly followed by family doctors and referent cardiologists. Doppler echocardiographic examinations were obtained annually in all patients. The midterm clinical, echocardiographic results and quality of life were analyzed. The mean follow-up was 5.3±3 (range 1-12) years. Results Hospital mortality was 1%. There were 10 late deaths (11%) including 5 cardiac cases. Two patients (2%) required an aortic valve or graft prosthesis reoperation. Aortic valve endocarditis occurred in two patients. Thromboembolic events were reported in three patients. None of the following morbidity has been observed: structural valve deterioration, nonstructural dysfunction, valve thrombosis, bleeding event. The 5- and 8-year survival were 92% and 88%, respectively. The 8-year survival free from cardiac death was 88%. The mean of EuroQoL visual analogue scale (EQ VAS) and EQ index were respectively 83±15 (range 30-100) and 0.94±0.12 (range 0.5-1). Conclusions Eight-year clinical improvement, function of the spared aortic valve and quality of life after valve sparing aortic root surgery appear excellent.
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Affiliation(s)
- Abdel-Kémal Bori Bata
- Heart Surgery Department, Clinical Research and Innovation Direction, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- Heart Surgery Department, Clinical Research and Innovation Direction, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistic's Unit, Clinical Research and Innovation Direction, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Etienne Geoffroy
- Heart Surgery Department, Clinical Research and Innovation Direction, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Nicolas Dauphin
- Heart Surgery Department, Clinical Research and Innovation Direction, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Vedat Eljezi
- Heart Surgery Department, Clinical Research and Innovation Direction, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Kasra Azarnoush
- Heart Surgery Department, Clinical Research and Innovation Direction, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Lucie Ulman
- Heart Surgery Department, Clinical Research and Innovation Direction, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | - Lionel Camilleri
- Heart Surgery Department, Clinical Research and Innovation Direction, Gabriel Montpied University Hospital, Clermont-Ferrand, France.,Clermont University, Université d'Auvergne, Clermont-Ferrand, France
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