Biological versus mechanical Bentall procedure for aortic root replacement: a propensity score analysis of a consecutive series of 1112 patients.

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.
(© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)