Article Sidebar

PDF
Date Published: 15/04/2022
Abstract Views: 308
Views PDF: 135
DOI: https://doi.org/10.47972/vjcts.v37i.760
Issue
Vol. 37
Section
Research Article
How to Cite
Dung, V. H. (2022). Modified Bentall procedure improves postoperative bleeding and medium-term survival. The Vietnam Journal of Cardiovascular and Thoracic Surgery, 37, 69-77. https://doi.org/10.47972/vjcts.v37i.760

Modified Bentall procedure improves postoperative bleeding and medium-term survival

Van Hung Dung

Main Article Content

Abstract

Background: Bentall procedure is a standard technique for complete aortic root replacements but a huge challenge is postoperative bleeding. This study was to evaluate the perioperative and long-term outcomes of the self-assembled composite graft with cuff formation for the Bentall procedure.


Methods: A retrospective study of all patients undergoing Bentall procedure with button technique was performed from 2000-2019. Group 1 included 40 patients with commercial composite graft and group 2 included 45 patients with self-assembled composite graft with cuff. Perioperative outcomes were blood loss, reoperation for bleeding, complications, and operative mortality. Long-term outcomes included overall and reoperation-free survival.


Results: Preoperative characteristics were similar in both groups, except mean age was higher in group 2 (48.2 versus 36.8 years). Group 2 significantly reduced blood loss in the first six hours postoperatively (250 versus 370 ml, P <0.001) and the risk of reoperation for bleeding (4.5% versus 17.5%, P = 0.002). Other complications were balanced between groups. Overall surgical mortality was 3. Reoperation was 7 cases. Group 2 also significantly improve the overall and reoperation-free survival: 95% and 95% (group 2) versus 75% and 70% (group 1) at four years respectively.


Conclusions: Self-assembled composite graft with cuff formation is safe and effective for Bentall procedure in the treatment of aortic root diseases with the reduction of bleeding and improvement of long-term survival. Further investigations are required to improve the feasibility and effectiveness of the procedure.

Article Details

Keywords

Bentall procedure, Self-assembled composite graft, Aortic disorders, Bleeding

References

1. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax 1968;23(4):338-339.
2. Etz CD, Bischoff MS, Bodian C et al. The Bentall procedure: Is it the gold standard? A series of 597 consecutive cases. J Thorac Cardiovasc Surg 2010;140(6 Suppl):S64-70; discussion S86-91.
3. Toy P, Gajic O, Bacchetti P et al. Transfusion-related acute lung injury: Incidence and risk factors. Blood 2012;119(7):1757-1767.
4. Roubinian N. TACO and TRALI: Biology, risk factors, and prevention strategies. Hematology Am Soc Hematol Educ Program 2018;2018(1):585-594.
5. Copeland JG, Rosado LJ, Snyder SL. New technique for improving hemostasis in aortic root replacement with composite graft. Ann Thorac Surg 1993;55(4):1027-1029.
6. Michielon G, Salvador L, Da Col U, Valfrè C. Modified button-Bentall operation for aortic root replacement: The miniskirt technique. Ann Thorac Surg 2001;72(3):S1059-1064.
7. Krasopoulos G, David TE, Armstrong S. Custom-tailored valved conduit for complex aortic root disease. J Thorac Cardiovasc Surg 2008;135(1):3-7.
8. Sokullu O, Sanioglu S, Orhan G et al. New use of teflon to reduce bleeding in modified Bentall operation. Tex Heart Inst J 2008;35(2):147-151.
9. Chen LW, Dai XF, Wu XJ. A modified composite valve dacron graft for prevention of postoperative bleeding from the proximal anastomosis after Bentall procedure. Ann Thorac Surg 2009;88(5):1705-1707.
10. Della Corte A, Baldascino F, La Marca F et al. Hemostatic modifications of the Bentall procedure: Imbricated proximal suture and fibrin sealant reduce postoperative morbidity and mortality rates. Tex Heart Inst J 2012;39(2):206-210.
11. Yang JA, Neely RC, Stewart AS. Modified Bentall procedure with composite biologic grafts. J Card Surg 2013;28(6):731-735.
12. Meszaros K, Liniger S, Czerny M et al. Mid-term results of aortic root replacement using a self-assembled biological composite graft. Interact Cardiovasc Thorac Surg. 2014;19(4):584-589.
13. Di Marco L, Pacini D, Pantaleo A et al. Composite valve graft implantation for the treatment of aortic valve and root disease: Results in 1045 patients. J Thorac Cardiovasc Surg 2016;152(4):1041-1048.e1041.
14. Beckerman Z, Leshnower BG, McPherson L, Binongo JN, Lasanajak Y, Chen EP. The evidence in a Bentall procedure with valsalva graft: Is this standard of care? J Vis Surg. 2018;4:98.
15. Karangelis D, Tzertzemelis D, Demis AA, Economidou S, Panagiotou M. Eighteen years of clinical experience with a modification of the Bentall button technique for total root replacement. J Thorac Dis 2018;10(12):6733-6741.
16. Kouchoukos NT, Haynes M, Baker JN. The button Bentall procedure. Oper Tech Thorac Cardiovasc Surg 2018;23(2):50-61.
17. Urbanski PP, Lakew F, Dinstak W et al. Bentall procedure after previous aortic valve or complete root replacement: Usefulness of self-assembled aortic valve conduit. J Thorac Cardiovasc Surg. 2018;156(1):89-95.e82.
18. Lechiancole A, Celiento M, Isola M et al. Modified bentall procedure: Mechanical vs biological valved conduits in patients older than 65 years. Int J Cardiol 2019;296:38-42.