Sixteen-year results of composite aortic root replacement for non-dissecting chronic aortic aneurysms

Background. The aim of this study was to evaluate the early and long-term outcomes in patients undergoing a Bentall procedure or its button modification for chronic aortic aneurysms with aortic valve incompetence. Methods. Between January 1986 and January 2002, 65 patients (84% males, mean age 58.9 ± 11 years) underwent aortic root replacement with a Bentall or a button-Bentall operation. Annuloaortic ectasia was the most frequent cause of aortic disease in this series (n = 37, 56.9%), followed by atherosclerotic aneurysms (n = 22, 33.9%), and post-stenotic dilation (n = 5, 7.7%). One patient (1.5%) underwent redo aortic root replacement, 3 (4.6%) had a Marfan syndrome, and 6 (92%) underwent a concomitant replacement of the aortic arch. The duration of follow-up ranged from 2 to 192 months (mean 89.6 ± 21.8 months). Results. The 30-day mortality was 0%. Early non-fatal complications comprised: bleeding requiring surgical re-exploration (n = 1, 15%), low output syndrome (n = 1, 1.5%), acute renal insufficiency (n = 1, 15%), transient ischemic attack (n = 2, 3.1%), stroke (n = 1, 15%), and pulmonary insufficiency (n = 1, 15%). There was a late death due to a pulmonary neoplasm.The 16-year actuarial survival was 97 ± 2% (hazard 0.02 ± 0.02). No patient required reoperation. Furthermore, the long- term clinical follow-up was characterized by the complete absence of endocarditis, anticoagulant-re- lated hemorrhage, valve thrombosis, and prosthetic failure. Finally, the NYHA functional status was significantly improved (1.1 ± 050, p < 0.001 vs preoperatively). Conclusions. The late results of the Bentall and button-Bentall procedures were excellent. Our findings confirm that these techniques still constitute the gold standard in the surgical treatment of combined valve and ascending aorta pathologies