title: Bentall Procedure: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  The Bentall procedure is considered the gold standard in the treatment of patients requiring aortic root replacement. An up-to-date overview of outcomes after the Bentall procedure is lacking.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of characteristics of and long-term outcome after the Bentall procedure with a mechanical valve prosthesis. Pooling was performed using the inverse variance method within a random-effects model. Outcome events are reported as linearized occurrence rates (percentage per patient year) with 95% confidence intervals.
  
  
  RESULTS
  In total, 46 studies with 7,629 patients (mean age, 50 years; 76% men) were selected. Pooled early mortality was 6% (422 patients). During a mean follow-up of 6 years (49,175 patient-years), the annual linearized occurrence rate for late mortality was 2.02% (1.77%- 2.31%; 892 patients), for aortic root reoperation it was 0.46% (0.36%-0.59%), for hemorrhage it was 0.64% (0.47%-0.87%), for thromboemboli it was 0.77% (0.60%-1.00%), for endocarditis it was 0.39% (0.33%-0.46%), and for major adverse valve-related events it was 2.66% (2.17%-3.24%). Operations performed in more recent years were associated with lower rates of aortic root reoperation (beta = -0.452; p = 0.015).
  
  
  CONCLUSIONS
  This systematic review illustrates that rates of aortic root reoperation after the Bentall procedure have decreased over the years. However, late mortality, major bleeding, and thromboembolic complications remain a concern. This report may be used to benchmark the potential therapeutic benefit of novel surgical approaches, such as valve-sparing aortic root replacement.
authors: Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: a.mookhoek@erasmusmc.nl.
authors: Aart
authors: A
authors: Mookhoek
authors: Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Nelleke M
authors: NM
authors: Korteland
authors: Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Bardia
authors: B
authors: Arabkhani
authors: Hôpital Foch, Suresnes, France.
authors: Isabelle
authors: I
authors: Di Centa
authors: Institut Mutualiste Montsouris, Paris, France.
authors: Emmanuel
authors: E
authors: Lansac
authors: Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Jos A
authors: JA
authors: Bekkers
authors: Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Ad J J C
authors: AJ
authors: Bogers
authors: Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: Johanna J M
authors: JJ
authors: Takkenberg
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data