Contemporary midterm echocardiographic outcomes of Bentall procedure and aortic valve sparing root replacement

Abstract

Background: Valve sparing root replacement (VSRR) and aortic valve repair (AVr) is an attractive treatment option compared with composite valve and root replacement (Bentall procedure) for patients with aortic root dilatation with or without aortic valve disease. While aortic valve preservation reduces the risk of valve-related complications, little is known about echocardiographic differences at follow-up between these 2 strategies.

Methods: Consecutive nonemergent patients undergoing VSRR and AVr (n=68) were compared with contemporary historical controls undergoing the Bentall procedure for aortic root pathology with or without mixed aortic valve disease (insufficiency or stenosis) (n=96). The VSRR was performed preferentially using the reimplantation technique. Bentall procedure utilized a mechanical valve in 65% of patients, a biologic prosthesis in 22%, and a homograft in 13%. Clinical and echocardiographic data were obtained at baseline and at follow-up (median=30 months).

Results: The 2 cohorts were similar with respect to all preoperative characteristics with the exception of disease etiology. The Bentall group had a higher proportion of degenerative valve and root disease (47.8% vs 27.9%) and a lower proportion of bicuspid aortic valve disease (22.8% vs 51.5%) as compared with the VSRR group (p=0.007). Postoperative echocardiographic outcomes were comparable between groups with the exception of higher peak (23.37±11.80 vs 18.0±12.04; p=0.02) and mean (13.07±7.53 vs 9.56±6.49; p=0.01) transvalvular aortic gradients in the Bentall group. Persistence of left ventricular dysfunction (8.4% vs 6.1%; p=0.61), presence of greater than moderate aortic valve (AV) insufficiency (3% vs 4.6%; p=0.32), and left ventricular mass (213.24±72.36 vs 207.38±63.07, p=0.61) were comparable between the Bentall and VSRR group, respectively. Finally, survival (p=0.21) and freedom from valve-related events (p=0.74) were similar between groups.

Conclusions: Valve sparing root replacement with AV repair provides similar mid-term echocardiographic and clinical outcomes compared with the Bentall.