Management of aortic root in type A dissection: Bentall approach. Issue 5 (20th December 2020) - Khachatryan, Zara
Abstract: Background: We analyzed the results of the modified Bentall procedure in a high‐risk group of patients presenting with acute type A aortic dissection (ATAAD). Methods: ATAAD patients undergoing a modified Bentall between 1996 and 2018 ( n = 314) were analyzed. Mechanical composite conduits were used in 45%, and biological ones using either a bioprosthesis implanted into an aortic graft (33%) or xeno‐/homograft root conduits (22%) in the rest. Preoperative malperfusion was present in 34% of patients and cardiopulmonary resuscitation required in 9%. Results: Concomitant arch procedures consisted of hemiarch in 56% and total arch/elephant trunk in 34%, while concomitant coronary artery surgery was required in 20%. The average cross‐clamp and cardiopulmonary bypass times were 126 ± 43 and 210 ± 76 min, respectively, while the average circulatory arrest times were 29 ± 17 min. A total of 69 patients (22%) suffered permanent neurologic deficit, while myocardial infarction occurred in 18 cases (6%) and low cardiac output syndrome in 47 (15%). The in‐hospital mortality rate was 17% due to intractable low cardiac output syndrome ( n = 29), major brain injury ( n = 16), multiorgan failure ( n = 6), and sepsis ( n = 2). The independent predictors of in‐hospital mortality were critical preoperative state (odds ratio [OR], 5.6; p < .001), coronary malperfusion (OR, 3.6; p = .002), coronary artery disease (OR, 2.6; p = .033), and prior cerebrovascular accident (OR, 5.6; p = .002). Conclusions: The modified Bentall operation, along with necessary concomitant procedures, can be performed with good early results in high‐risk ATAAD patients presenting.