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Management of Aortic Root in Type A Dissection: Bentall Approach
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  • Zara Khachatryan,
  • Sergey Leontyev,
  • Khadzhimurad Magomedov,
  • Josephina Haunschild,
  • David Holzhey,
  • Martin Misfeld,
  • Christian Etz,
  • Michael Borger
Zara Khachatryan
Leipzig Heart Centre University Hospital
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Sergey Leontyev
Leipzig Heart Centre University Hospital
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Khadzhimurad Magomedov
Leipzig Heart Centre University Hospital
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Josephina Haunschild
Leipzig Heart Centre University Hospital
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David Holzhey
Leipzig Heart Centre University Hospital
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Martin Misfeld
Leipzig Heart Centre University Hospital
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Christian Etz
Leipzig Heart Centre University Hospital
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Michael Borger
Leipzig Heart Centre University Hospital
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Abstract

Background: We analysed 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 analysed. Mechanical composite conduits were used in 45%, and biological 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 24%. Average crossclamp and cardiopulmonary bypass times were 126 ± 43 and 210 ± 76 minutes, respectively, while average circulatory arrest times were 29 ± 17 minutes. 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%). 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). Independent predictors of in-hospital mortality were critical preoperative state (OR, 5.6; p < 0.001), coronary malperfusion (OR, 3.6; p = 0.002), coronary artery disease (OR, 2.6; p = 0.033) and prior cerebrovascular accident (OR, 5.6; p = 0.002). Conclusions: The modified Bentall operation, along with necessary concomitant procedures, can be performed with good early results in high risk ATAAD patients presenting.

Peer review status:IN REVISION

22 Aug 2020Assigned to Editor
22 Aug 2020Submission Checks Completed
22 Aug 2020Reviewer(s) Assigned
24 Aug 2020Review(s) Completed, Editorial Evaluation Pending
31 Aug 2020Editorial Decision: Revise Major