Bio-Bentall procedure versus isolated biological aortic valve replacement: a case-match study

OBJECTIVES: The aim of the study was to evaluate whether a complete aortic root replacement using a composite graft with biological valve prosthesis carries a higher early or late postoperative risk than isolated valve replacement. METHODS: Between 1998 and 2008, 182 consecutive patients underwent complete aortic root and ascending aorta replacement using a self-assembled composite graft with a biological valve prosthesis located within the vascular tube (modified Bentall procedure). In the same period, 1959 patients received an isolated aortic valve replacement using a biological valve prosthesis. After matching the patients using five variables (sex, age-by 5-year increments, aortic valve defect, concomitant coronary surgery and the year of surgery), 79 perfectly matched pairs were found. Regarding other clinically essential but unmatched preoperative characteristics, there were no relevant differences between the groups. RESULTS: There was no statistically significant difference in the early postoperative mortality (30-day and/or in-hospital), which was 5.1% (4 patients) in the Root Group (RG) and 3.8% (3 patients) in the Valve Group (VG). The follow-up was complete for all patients and contained 499 patient-years in the RG versus 488 in the VG. In total, there were 23 deaths in each group during the follow-up time, which was 6.2 ± 2.8 years for the RG and 6.2 ± 3.2 years for the VG. Hence, the linearized death rate and actuarial survival at 10 years were almost identical. They were 4.66%/year and 63.2 ± 8.3%, respectively, in the RG; compared with 4.71%/year and 58.5 ± 9.3% in the VG. Also the rates of valve-related morbidities were similar except for the tendency of a lower rate of cerebral embolism in the RG. CONCLUSIONS: Complete aortic root replacement with a biological composite graft can be performed by experienced surgeons with an operative risk similar to that of an isolated biological aortic valve replacement. Starting with comparable operative outcomes, both procedures offer almost identical long-term survival. The rates of valve-related events after complete aortic root replacement and isolated valve replacement are also comparable, apart from cerebral embolism, which seems to be less frequent after aortic root replacement.