title: Is the Bentall procedure for ascending aorta or aortic valve replacement the best approach for long-term event-free survival?
abstract: BACKGROUND
  This retrospective analysis of a selected series of Bentall procedures may be useful in evaluating the results of valve-sparing operations, an increasingly popular alternative for replacement of the ascending aorta and aortic valve.
  
  
  METHODS
  One hundred forty-two elective patients younger than 65 years without concomitant procedures who underwent replacement of the thoracic aorta and aortic valve between 1989 and 2000 were studied; 85% were men, and the median age was 46 years (range, 13 to 64 years). Degenerative disease of the aorta was the most common cause requiring operation (86%, including 46% with a bicuspid aortic valve); 8% had chronic dissection, and 6% had atherosclerotic aneurysms. The ascending aorta was replaced in 94 patients (66%); 45 patients (32%) underwent hemiarch replacement, and in 3 patients (2%) the total arch was replaced. A mechanical valve was used in 88%, and a biologic valve, in 12%.
  
  
  RESULTS
  There were no intraoperative deaths. Two patients had a stroke postoperatively, one of which was fatal. Complications during follow-up included 2 cases of endocarditis, 1 peripheral thromboembolic event, and 10 instances of significant bleeding (requiring hospitalization or transfusion). Surgery for distal aortic segments was performed in 4 patients, but no patient required reoperation in the proximal aorta. Kaplan-Meier curves show overall survival is 0.95 (95% confidence intervals, 0.9 to 0.99) at 5 years and 0.93 (95% confidence intervals, 0.86 to 0.99) at 8 years, and event-free survival is 0.85 (95% confidence intervals, 0.78 to 0.92) at 5 years and 0.78 (95% confidence intervals, 0.68 to 0.88) at 8 years.
  
  
  CONCLUSIONS
  The button Bentall procedure can be performed with excellent short-term and long-term results in relatively uncomplicated elective patients in whom aortic valve disease is combined with dilatation of the ascending aorta. Results of this traditional operation are the standard against which the long-term outcome of newer approaches, such as valve-sparing operations, should be compared.
authors.affiliation: Department of Cardiothoracic Surgery, New York, New York 10029, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
authors.forename: Justus T
authors.initials: JT
authors.lastname: Strauch
authors.forename: David
authors.initials: D
authors.lastname: Spielvogel
authors.forename: Jan D
authors.initials: JD
authors.lastname: Galla
authors.forename: Steven L
authors.initials: SL
authors.lastname: Lansman
authors.forename: Rafael
authors.initials: R
authors.lastname: Squitieri
authors.forename: Carol A
authors.initials: CA
authors.lastname: Bodian
authors.forename: Randall B
authors.initials: RB
authors.lastname: Griepp
mesh_terms: D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000379:methods*