title: The Bentall procedure: is it the gold standard? A series of 597 consecutive cases.
abstract: OBJECTIVE
  We compared aortic root reconstructions using conduits with biological valves and mechanical valves.
  
  
  METHODS
  Of 597 patients (1995-2008), 307 (mean age 71 years [23-89 years]) had biological valves and 290 (mean age 51 years [21-82 years]) had mechanical valves. The subgroup of 242 patients aged 50 to 70 years included 133 with biological and 109 with mechanical valves.
  
  
  RESULTS
  Overall hospital mortality was 3.9% with biological valves (n = 15; elective: 3.7% [n = 10]) versus 2.8% with mechanical valves (n = 8; elective: 1.4% [n = 3]). In patients 50 to 70 years, age greater than 65 years (relative risk: 3.3 [P = .0001]), clot (relative risk: 2.5 [P = .05]), coronary artery disease (relative risk:3.5 [P < .0001]), and degenerative etiology (relative risk: 0.4 [P = .006]) were independent risk factors for long-term survival (after postoperative day 30); there was no difference in long-term survival between biological and mechanical valves (relative risk: 0.9 [P = .74]). The linearized rate for valve/ascending aorta reoperation was 0.86%/pt-y (2 in 2310 pt-y) after mechanical valves and 2.5%/pt-y (4 in 1586 pt-y) after Bentall procedures with the biological valve.
  
  
  CONCLUSIONS
  The choice of valve for aortic root reconstruction seems to have no influence on long-term outcome. Emergency operation and the presence of clot/atheroma have a significant impact on short-term outcome. Reoperation for either ascending aorta and/or aortic valve is low.
authors.affiliation: Departments of Cardiothoracic Surgery and Anesthesia, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Etz
authors.forename: Moritz S
authors.initials: MS
authors.lastname: Bischoff
authors.forename: Carol
authors.initials: C
authors.lastname: Bodian
authors.forename: Fabian
authors.initials: F
authors.lastname: Roder
authors.forename: Robert
authors.initials: R
authors.lastname: Brenner
authors.forename: Randall B
authors.initials: RB
authors.lastname: Griepp
authors.forename: Gabriele
authors.initials: G
authors.lastname: Di Luozzo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009519:New York City; D016017:Odds Ratio; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult