A simple modified Bentall technique for surgical reconstruction of the aortic root - short and long term outcomes.
BACKGROUND
Since the first introduction of the Bentall technique, several modifications have been proposed to improve patient outcomes and decrease intra- and post-operative complications. We describe a simplified modification of the technique that tries to lessen the intra-operative time, improve homeostasis and miminize early and late complications. Our experience with the technique and short- and long-term patient outcomes are reported.


METHODS
From August 1996 to October 2013, 110 consecutive patients underwent this modified technique. The procedure used Dacron composite graft with a mechanical valve (St. Jude Medical®) for aortic root replacement. To avoid intra-operative complications, no mobilization of coronary ostia was done. Additionally, the tubular aorta was kept minimally unchanged.


RESULTS
Total bleeding after the operation was 450 ± 105 mL. The mean duration of intensive care unit and hospital stay were 2 ± 1 and 5 ± 2 days, respectively. Sixty-six patients (60 %) were discharged from the surgical intensive care unit on the first postoperative day, 34 patients (30.9 %) were discharged on the second day and ten patients (9.1 %) needed more time to stay in the intensive care unit due to haemodynamic or respiratory problems. At 5-years follow up, survival rate was 97 %. In the three deceased patients, causes of death were mediastinitis, sepsis and myocardial infarction. No operation-related complications such as anticoagulant-related hemorrhage, valve or graft thrombosis, or coronary pseudoaneurysm were occurred during follow-up.


CONCLUSIONS
The proposed modification of the Bentall technique seems to minimize late intra-operative blood loss, improves homeostasis, shortens the operation time and is associated with excellent long-term outcomes in patients undergoing composite graft replacement of the aortic root.
Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, P.O. Box: 9137913316, Mashhad, Iran.
Pouya
P
Nezafati
Javad Al Aemeh Hospital, Mashhad, Iran.
Ali
A
Shomali
Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, P.O. Box: 9137913316, Mashhad, Iran. mhnezafati@yahoo.com.
Mohammad Hassan
MH
Nezafati
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D000925:Anticoagulants / Q000627:therapeutic use; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D019106:Postoperative Hemorrhage / Q000209:etiology; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
D000925:Anticoagulants; D011093:Polyethylene Terephthalates