1. Biological versus mechanical Bentall procedure for aortic root replacement: a propensity score analysis of a consecutive series of 1112 patients†
- Author
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Alessandro Leone, Roberto Di Bartolomeo, Luca Di Marco, Giacomo Murana, Paolo Berretta, Antonio Pantaleo, Giuseppe Barberio, Davide Pacini, Giuliano Jafrancesco, Pantaleo, Antonio, Murana, Giacomo, Di Marco, Luca, Jafrancesco, Giuliano, Barberio, Giuseppe, Berretta, Paolo, Leone, Alessandro, Di Bartolomeo, Roberto, and Pacini, Davide
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Bentall procedure ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Preoperative care ,Prosthesis ,Blood Vessel Prosthesis Implantation ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,medicine.artery ,Internal medicine ,Ascending aorta ,medicine ,Aortic root ,Humans ,Hospital Mortality ,Propensity Score ,Aged ,Retrospective Studies ,Bioprosthesis ,Heart Valve Prosthesis Implantation ,Aorta ,Aortic Aneurysm, Thoracic ,business.industry ,Hazard ratio ,Aortic Valve Stenosis ,General Medicine ,Middle Aged ,medicine.disease ,Confidence interval ,Surgery ,Treatment Outcome ,Italy ,030228 respiratory system ,Aortic Valve ,Propensity matching ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Objectives In this study, a propensity-matching analysis was used to compare biological versus mechanical composite valve graft implantation for early mortality and morbidities and for late complications including the need for aortic reintervention. Methods Between 1978 and 2011, 1112 consecutive patients underwent a complete aortic root replacement using either a biological Bentall (BB, n = 356) or a mechanical Bentall (MB, n = 756) valve conduit. Preoperative data were stratified according to the type of valve graft, and treatment bias was addressed by propensity score analysis. Results Two homogeneous groups of 138 patients were obtained. Hospital mortality between them was comparable (MB = 7.2% and BB = 5.8%, P = 0.6). They also had similar results after a mean follow-up time of 40 ± 38 months. Propensity-adjusted Cox-regression analysis showed no relationship between the type of prosthesis and all-cause mortality at follow-up (hazards ratio: 0.88; 95% confidence interval: 0.50-2.14; P = 0.4). Freedom from proximal aortic reintervention at 1, 5 and 7 years was 99.1 ± 0.9% in the MB group compared with 98.4 ± 1.1%, 93.0 ± 3.2% and 93.0 ± 3.2% in the BB group (long-rank P = 0.07). Conclusions The Bentall procedure is a safe and reproducible treatment for ascending aorta pathologies. The choice of either a mechanical or a biological valve graft seems to have no influence on early and late midterm adverse outcomes including need for aortic reinterventions.
- Published
- 2017
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