title: Modified Bentall procedure using two short grafts for coronary reimplantation: long-term results.
abstract: BACKGROUND
  The modified Bentall procedure remains a gold standard of aortic root surgery. We present in this study the early and late outcomes of a particular modification using 2 separated grafts for the coronary reimplantation.
  
  
  METHODS
  From 1995 to 2009, 153 patients aged 57±12 (mean±standard deviation [SD]) underwent elective (n=113) or urgent (n=40) aortic root replacement with a composite mechanical valve conduit reconstruction using 2 short, separated 8-mm Dacron grafts for the coronary reimplantation and were retrospectively reviewed.
  
  
  RESULTS
  Aortic disease etiologies were annuloaortic ectasia (n=108), type A aortic dissection (n=38), aortic false aneurysm, or Valsalva aneurysm evolution after previous cardiac surgery (n=7). The overall early mortality was 8.5% (20% for urgent procedure and 4.4% for elective procedure). For the whole group, actuarial survival at 5 and 10 years was 86.3%±2.78 and 73.7%±4.23, respectively. Among the 23 late deaths, 9 were valve-related deaths (stroke, n=3; endocarditis, n=1; unknown, n=5). During the follow-up, linearized rates of major bleeding, thromboembolism, and endocarditic evolution were, respectively, 1.3 %/patient-years, 0.42 %/patient-years, and 0.22 %/patient-years. One patient presented a nonseptic false aneurysm of the right coronary anastomosis and no structural valve dysfunction has been diagnosed. In total, only 2 patients required an aortic root reoperation.
  
  
  CONCLUSIONS
  The modified Bentall procedure using 2 separated grafts for the coronary reimplantation is a feasible, safe, easy, and reproducible operative technique for aortic root surgery.
authors.affiliation: Department of Cardio-Vascular Surgery, University Hospital, and School of Surgery, Faculty of Medicine, University Henri Poincaré, Nancy, France.
authors.forename: Pablo
authors.initials: P
authors.lastname: Maureira
authors.forename: Fabrice
authors.initials: F
authors.lastname: Vanhuyse
authors.forename: Cécile
authors.initials: C
authors.lastname: Martin
authors.forename: Malik
authors.initials: M
authors.lastname: Lekehal
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Carteaux
authors.forename: Nguyen
authors.initials: N
authors.lastname: Tran
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Villemot
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D017541:Aneurysm, False / Q000601:surgery; D000925:Anticoagulants / Q000627:therapeutic use; D001014:Aortic Aneurysm / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery*; D004108:Dilatation, Pathologic / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D013923:Thromboembolism / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D011093:Polyethylene Terephthalates