Mid-term follow-up of aortic root remodelling compared to Bentall operation

Objectives: Aortic Valve sparing with root remodelling has proven useful in cases of aortic regurgitation secondary to ascending aorta disease. An exc essive rate of re-operation for recurrent aortic regurgitation after this c onservative approach might compensate the prosthesis-related risk of the Be ntall operation. Methods: From January 1995 to September 2000, 69 consecuti ve patients with aortic expansive aneurysm and concomitant aortic valve dis ease, were submitted to the Bentall operation (group A, n = 37) in the pres ence of an abnormal valve, or to root remodelling (group B, n = 32) in case s of secondary aortic incompetence. One patient in group A and four in grou p B had Marfan syndrome. The follow-up was 1021 patient-months (range, 1-68 months) in group A and 926 in group B (1-64 months). The event-free surviv al was calculated using the Kaplan-Meier method, and the difference between curves was evaluated using the Mantel-Cox log-rank test. Results: The oper ative mortality was 5% in group A and 0% in group B. One patient died at fo llow-up in group A and none in group B. Four patients (three Marfan) in gro up B were re-operated on because of recurrent aortic regurgitation. The 5-y ear event-free survival was 88 +/- 7% in group A and 82 +/- 8% in group B ( P = 0.58). Early residual aortic regurgitation remained stable over time on ly in patients with good early results. Conclusions: Mid-term follow-up fai led to reveal statistically significant differences in the clinical outcome between remodelling and the Bentall operation. Our results support the wid espread use of root remodelling, provided that an indication to this conser vative approach is achieved after careful, case-by-case evaluation. A good early operative result is likely to remain stable over time. (C) 2001 Elsev ier Science B.V. All rights reserved.