Embolic and bleeding events after modified Bentall procedure in selected patients

Costin N Radu ¹, Matthias E W Kirsch ^1*, Marie Line Hillion ¹, Frank Lagneau ¹, Ludovic Drouet ² and Daniel Y Loisance ¹

¹ Henri Mondor Hospital, France
² Hôpital Lariboisière, France

^* To whom correspondence should be addressed. E-mail: matthias.kirsch{at}hmn.aphp.fr.

Accepted 2 June 2006

Abstract

Aims As valve sparing procedures gain increasing popularity, we wished to evaluate the long term results of the total aortic root replacement (TARR) using mechanical valved grafts in selected patients.

Methods and Results From Jan. 1993 to Dec. 2003, 100 patients (87 men), younger than 65 years (51± 10.4), presenting isolated aortic root dilatation with or without aortic valve insufficiency, undergoing elective root replacement using a mechanical valved graft were reviewed. Etiology of aortic root disease was degenerative in 69 (69%) and related to bicuspid aortic valve in 31 patients (31%). In 11 patients (11%) concomitant CABG was performed. Hospital mortality was 4%. Overall survival was 93.9±2.4%, 89.1±3.5% and 83.2±5.2% at 1 year, 5 and 7 years respectively. Fourteen patients suffered 45 embolic events (3.21±2.64 events/patient; range: from 1 to 10 events). Thus, linearized rate of embolic events was 10.3 per 100 patients-years [95% CL, 7.29 - 13.31]. Actuarial embolism free survival was 96.6±1.9%, 77.1±6% and 74.3±6.4% at 1 year, 5 and 7 years respectively. Linearized rate of bleeding events was 2.2 per 100 patient-years [95% CL, 0.87 - 3.71]. Actuarial bleeding free survival was 95.6±2.1%, 93.2±2.6% and 87.7±5.8% at 1 year, 5 and 7 years respectively. No patient required reoperation and no case of structural or non-structural valve dysfunction were observed.

Conclusions TARR using mechanical valved grafts yields excellent survival results in selected patients. However, we recorded a high rate of minor thromboembolic events. Aspirin in combination with oral anticoagulants might be of potential interest in these patients.

Keywords: Bentall procedure, aortic root replacement, bleeding, embolism, surgery

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