Outcome after the modified Bentall technique with a long interposed graft to the left coronary artery.
BACKGROUND
The modified Bentall technique, which was reported by Svensson in 1992, is an aortic root composite valve graft replacement involving reimplantation of the left coronary ostium with a long interposed graft wrapping behind the composite graft. The technique is technically advantageous, particularly for complicated or redo aortic roots. To justify the technique, the midterm outcome needs to be evaluated.


METHODS
Since 1992, 40 patients (4 with Marfan syndrome) underwent the modified Bentall technique (Svensson's modification). The mean age was 54.7 +/- 13.6 years, and 32 patients (80.0%) were male. All hospital survivors have been consecutively followed with annual echocardiographic evaluations. Furthermore, in 2007, multislice computed tomography was performed at 4.7 +/- 3.5 years (maximum, 14.9 years) postoperatively in 30 patients who had preserved renal function.


RESULTS
No patients have experienced any complications regarding the technique at the follow-up of 5.7 +/- 4.0 years (maximum, 14.9 years), although there were 2 hospital deaths of emergency cases and 5 late deaths owing to noncardiac causes. In 35 patients (92.1% of hospital survivors), no structural complications were detected by multislice computed tomographies of the 30 patients or coronary angiograms of the remaining 5 patients. The consecutive echocardiographic follow-ups showed well-preserved left ventricular function with the most recent ejection fraction being 0.581 +/- 0.078.


CONCLUSIONS
This Svensson's modification technique was associated with favorable midterm outcomes by multislice computed tomography and consecutive echocardiographic evaluations, indicating long-lasting advantages as well as technical benefits. Thus, the technique can be considered as a helpful and justifiable alternative method.
Nakahira
Atsushi
A
Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. osushi123@med.osaka-cu.ac.jp
Shibata
Toshihiko
T
Sasaki
Yasuyuki
Y
Hirai
Hidekazu
H
Hattori
Koji
K
Hosono
Mitsuharu
M
Ehara
Shoichi
S
Suehiro
Shigefumi
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001027:Aortography; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D003331:Coronary Vessels / Q000601:surgery*; D015150:Echocardiography, Doppler; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome