Thorac Cardiovasc Surg 2016; 64(02): 116-123
DOI: 10.1055/s-0035-1552580
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Is Bentall Procedure Still the Gold Standard for Acute Aortic Dissection with Aortic Root Involvement?

Erik Beckmann
1   Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany
*   Both authors contributed equally.
,
Andreas Martens
1   Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany
*   Both authors contributed equally.
,
Firas Abd Alhadi
1   Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany
,
Fabio Ius
1   Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany
,
Nurbol Koigeldiyev
1   Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany
,
Felix Fleissner
1   Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany
,
Penelope Stiefel
1   Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany
,
Tim Kaufeld
1   Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany
,
Axel Haverich
1   Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany
,
Malakh Shrestha
1   Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany
› Author Affiliations
Further Information

Publication History

01 February 2015

16 March 2015

Publication Date:
19 June 2015 (online)

Abstract

Introduction The “ideal” treatment of acute aortic dissection type A (AADA) with dissected and dilated root is controversial. We compared the outcome of classical Bentall procedure (biological and mechanical) with valve-sparing David procedure.

Methods Between January 2002 and July 2011, 119 patients with AADA and aortic root involvement underwent surgery at our center. Thirty-one patients (group 1) received biological conduits, 41 (group 2) received mechanical conduits, and 47 (group 3) underwent David procedures.

Results Cross-clamp, cardiopulmonary bypass, and circulatory arrest times were 151 ± 52, 232 ± 84, and 36 ± 30 minutes (group 1); 148 ± 44, 237 ± 91, and 45 ± 29 minutes (group 2); and 160 ± 46, 231 ± 63, and 35 ± 17 minutes (group 3), respectively. The 30-day mortality rates were 32.3% (group 1), 22% (group 2), and 12.8% (group 3). The 1-year rates for freedom from valve-related reoperation were 100% (group 1), 92.5% (group 2), and 95.2% (group 3) (p = 0.172). The 1-year survival rates were 61% (group 1), 61% (group 2), and 84.1% (group 3) (p = 0.008).

Conclusion Even in AADA patients with root involvement, David procedure has acceptable results. David procedure (if possible) or a Bio-Bentall (for pathological valves) seems to be the optimal technique.

 
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