title: Bentall procedure: quarter century of clinical experiences of a single surgeon.
abstract: BACKGROUND
  We retrospectively analyzed 25 years of experiences with the button Bentall procedure in patients with aortic root pathologies. Even though this procedure has become widespread, there are only a few very long term follow-ups available in the clinical literature, especially regarding single surgeon results.
  
  
  METHODS
  Between 1988 and 2013, a total of 147 patients underwent the Bentall procedure by the same surgeon. Among them there were 62 patients with Marfan syndrome. At the time of the surgery the mean age was 46.5 ± 17.6 years. The impact of surgical experience on long-term survival was evaluated using a cumulative sum analysis chart.
  
  
  RESULTS
  The Kaplan-Meier estimated overall survival rates for the 147 patients were 91.8 ± 2.3 %, 84.3 ± 3.1 %, 76.3 ± 4.9 % and 59.5 ± 10.7 % at 1,5,10 and 20 years, respectively. Multivariate Cox regression analysis identified EuroSCORE II over 3 % (OR 4.245, 95 % CI, 1.739-10.364, p = 0.002), acute indication (OR 2.942, 95 % CI, 1.158-7.480, p = 0.023), use of deep hypothermic circulatory arrest (OR 3.267, 95 % CI, 1.283-8.323, p = 0.013), chronic kidney disease (OR 6.865, 95 % CI, 1.339-35.189, p = 0.021) and early complication (OR 3.134, 95 % CI, 1.246-7.883, p = 0.015) as significant risk factors for the late overall death. The survival rate for freedom from early complication was 94.3 ± 2.2 %, 88.0 ± 3.3 %, 82.9 ± 4.7 % and 69.2 ± 8.4 % at 1,5,10 and 20 years. The main pathological findings of the aortic wall were cystic medial degeneration in 75 %, fibrosis in 6 %, atherosclerosis in 13 % and no pathological alteration in 6 % of the samples. The overall survival rate was significantly lower in patients operated in first 15 years compared to patients operated in the last decade (log-rank p = 0.011).
  
  
  CONCLUSIONS
  According to our long-term follow-up the Bentall operation provides an appropriate functional result by resolving the lesions of the ascending aorta. Based on our results, 25-30 operations done is necessary to gain such a level of confidence and experience to aquire better results on long-term survival. In addition, we discussed that there were no co-morbidities affecting on the survival of Marfan patients and prophylactic aortic root replacement ensures a longer survival among patients with Marfan syndrome.
authors.affiliation: Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary. kalman.benke@gmail.com.|Hungarian Marfan Foundation, Budapest, Hungary. kalman.benke@gmail.com.
authors.forename: Kálmán
authors.initials: K
authors.lastname: Benke
authors.affiliation: Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.|Hungarian Marfan Foundation, Budapest, Hungary.
authors.forename: Bence
authors.initials: B
authors.lastname: Ágg
authors.affiliation: Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.
authors.forename: Lilla
authors.initials: L
authors.lastname: Szabó
authors.affiliation: Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.|MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors.forename: Bálint
authors.initials: B
authors.lastname: Szilveszter
authors.affiliation: Department of Pulmonology, Semmelweis University, Budapest, Hungary.
authors.forename: Balázs
authors.initials: B
authors.lastname: Odler
authors.affiliation: Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.
authors.forename: Miklós
authors.initials: M
authors.lastname: Pólos
authors.affiliation: Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.
authors.forename: Chun
authors.initials: C
authors.lastname: Cao
authors.affiliation: Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.|MTA-SE Lendület Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
authors.forename: Pál
authors.initials: P
authors.lastname: Maurovich-Horvat
authors.affiliation: Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Radovits
authors.affiliation: Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.
authors.forename: Béla
authors.initials: B
authors.lastname: Merkely
authors.affiliation: Heart and Vascular Center, Semmelweis University, H-1122 Városmajor str. 68, Budapest, Hungary.|Hungarian Marfan Foundation, Budapest, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Szabolcs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008382:Marfan Syndrome / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult