Bio-Bentall With Self-Assembled Composite Graft: An Update After Two Decades of Experience.

Background: The aim of the study was to evaluate the long-term results after aortic root replacement using a self-assembled composite graft with a biological valve prosthesis.

Methods: Between 1998 and 2021, a total of 308 bio-Bentall procedures were performed by use of the described technique exclusively. The average age of the cohort patients was 68.5 ± 9.0 years; 77 patients were younger than 65 years (mean, 55.9 ± 7.4 years). The indication for root replacement was chronic aneurysm in 215 patients (69.8%).

Results: Early (30-day/in-hospital) mortality was 4.9% for the entire cohort and 0% for the patients with chronic root aneurysm. The survival at 15 years was 41.9% ± 4.1% for all patients and 62.5% ± 9.3% for those younger than 65 years. Multivariate statistical analysis revealed patient's age, New York Heart Association class IV, no sinus rhythm, and postoperative dialysis as independent risk factors for late mortality. The cumulative risk of aortic valve reintervention due to prosthesis degeneration at 15 years was 7.7% ± 2.45%. During the mean follow-up of 96 months (range, 0-279 months), there were 19 reinterventions on the aortic valve or root altogether. In patients with acute endocarditis (7), a complete root re-replacement was necessary, yet in all 12 patients with valve degeneration, the reintervention (open re-replacement in 10, valve-in-valve in 2) could be limited to the aortic valve prosthesis, leaving the aortic tube and coronary ostia untouched.

Conclusions: Aortic root replacement by the described self-assembled biological valve composite graft enables a safe replacement of the degenerated valve prosthesis within the conduit and can therefore be recommended in younger patients.