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Ann Thorac Surg. 2016 May;101(5):1684-9. doi: 10.1016/j.athoracsur.2015.10.090. Epub 2016 Feb 6.

Bentall Procedure: A Systematic Review and Meta-Analysis.

Author information

1
Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: a.mookhoek@erasmusmc.nl.
2
Erasmus University Medical Center, Rotterdam, The Netherlands.
3
Hôpital Foch, Suresnes, France.
4
Institut Mutualiste Montsouris, Paris, France.

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.

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