Long Term Results of the Modified Bentall Procedure With Mechanical and Biological Composite Valve Grafts.

Objectives: Despite the evident shift toward biological prostheses, the optimal choice of valve remains controversial in composite valve graft (CVG) replacement. We investigated long-term morbidity and mortality after CVG implantation in an all-comer cohort with a subgroup analysis of patients aged 50-70 years stratified after valve type.
Methods: A total of 507 patients underwent the Bentall procedure with either a mechanical (MCVG, n = 299) or a biological (BCVG n = 208) CVG replacement between 2000 and 2020. A single-center analysis comprising clinical and telephone follow-up was conducted to investigate late mortality and morbidity.
Results: The 30-day mortality in all patients [age 56 ± 14 years, 78.1% male, EuroSCORE II 3.12 (1.7; 7.1)] was 5.9%. Patients who were electively operated on had a 30-day mortality of 1.5% ( n = 5) while it remained higher in urgent/emergent procedures ( n = 25, 15.4%). Survival at 10 and 15 years was 78.19 ± 2.26% and 72.6 ± 3.2%, respectively. In patients aged 50-70 years ( n = 261; MCVG = 151, BCVG = 110), survival did not differ significantly between the valve groups ( p = 0.419). Multivariable analysis showed no significant impact of valve type on survival ( p = 0.069). A time-varying relation with survival was notable, showing a higher risk in the MCVG group in the early postoperative phase, which declined compared to the BCVG group in the course of follow-up.
Conclusions: The Bentall technique presents with excellent mortality when performed electively. The type of valve prosthesis showed no statistically significant effect on mortality in patients aged 50-70 years. However, a time-varying relation showing an initially higher risk with MCVG which decreased compared to BCVG at long-term follow-up was notable. Further studies with even longer follow-up of BCVGs will clarify the ideal choice of prosthesis in this patient subset.
Competing Interests: MA is a proctor, speaker, consultant in Abbott, Edwards, Medtronic, and received institutional funding (Abbott, Edwards, Medtronic, LSI). AKo is a proctor (Edwards) and received speaker fees (Edwards). GL is an advisory-board member (Edwards). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(Copyright © 2022 Werner, Gritsch, Kaider, Coti, Osorio, Mahr, Stelzmueller, Kocher, Laufer, Andreas and Ehrlich.)