INFLUENCE OF THE AORTIC PATHOLOGY ON THE RESULTS OF THE BENTALL PROCEDURE

The results of 51 patients undergoing the Bentall procedure for aneury smal pathology of the ascending aorta during the last 10 years are ana lysed with respect to the nature of the pathology of the lesions of th e arterial wall. The study population comprised 39 men and 12 women wi th a mean age of 47 +/- 17 years (range 2-76 years). They were divided into two groups, Group I (n = 38) with degenerative cystic medianecro sis, Group II (n = 13) with atheromatous lesions. The overall results were satisfactory with a hospital mortality of 3.9 % and 5 and 10 year survival rates of 94 and 74 % respectively. No difference in results was observed with respect to the anatomical site of the aneurysm, the presence of dissection or the technique used for repair. The results i n degenerative lesions (Group I) were excellent but the accent should be placed on prevention to reduce the number of patients operated in a context of acute dissection. The presence of atheromatous lesions ide ntifies a high risk group (Group Il) due to advanced age, hypertension and associated vascular and coronary lesions. The hospital mortality in this group was 15.4 % compared to almost nil when the aneurysmal pa thology was due to degenerative lesions of the media. The extramortali ty of this group is directly related to the presence of atheromatous l esions (mesenteric infarction due to atheromatous embolism) and incite s special attention to the mesenteric sphere in the postoperative peri od. The preoperative work-up should include transoesophageal echocardi ography of the thoracic aortic wall, probably the source of the postop erative emboli.