Long-Term Mortality and Morbidity after Button Bentall Operation

Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon, Republic of Korea.
Journal of Cardiac Surgery (Impact Factor: 0.89). 03/2013; 28(3). DOI: 10.1111/jocs.12085
Source: PubMed


The purpose of this study is to evaluate the long-term outcomes of the button Bentall procedure for the correction of aortic root disease.
A total of 195 patients who underwent the button Bentall procedure between 1997 and 2010 were studied. The main pathology was annuloaortic ectasia. A mechanical valve was used in 163 patients (83.6%). The median duration of follow-up was 64 months (14133.0 patient-years).
There were five operative deaths (2.6%). Late overall mortality was 7.9%. The actuarial overall survival rate was 95.8 ± 1.5% at 5 years, 89.6 ± 3.4% at 10 years, and 75.9 ± 7.3% at 15 years. Multivariate logistic regression analysis identified preoperative poor mobility, cardiopulmonary bypass time, deep hypothermic circulatory arrest (DHCA) use, embolism, and bleeding event as significant independent risk factors for the late overall mortality. At 5, 10, and 15 years, actuarial composite valve graft-related event-free survival was 85.8 ± 2.8%, 75.5 ± 4.4%, and 69.3 ± 7.3%, respectively. Hypertension and concomitant coronary artery bypass graft (CABG) were independent predictors of composite valve graft-related events. Age, concomitant CABG, and DHCA use were associated with bleeding.
Valve-related morbidities, such as embolism and bleeding, determine the long-term overall mortality in aortic root replacement with button Bentall operation, similar to that in routine valve surgery. doi: 10.1111/jocs.12085 (J Card Surg 2013;28:280–284)

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    • "Long-term mortality of the Button Bentall method was shown to be related to embolism and bleeding events similar to valve surgery. Contaminant CABG also increased bleeding risk for patients undergoing the Bentall procedure [10]. Midulla and colleagues comment that late mortality in patients is often due to a subsequent aneurysm or dissection along the aorta even in patients not presenting with a genetic defect affecting aortic structure. "
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