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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:Published

22 Aug 2020Submission Checks Completed
22 Aug 2020Assigned to Editor
22 Aug 2020Reviewer(s) Assigned
24 Aug 2020Review(s) Completed, Editorial Evaluation Pending
31 Aug 2020Editorial Decision: Revise Major
25 Nov 20201st Revision Received
26 Nov 2020Assigned to Editor
26 Nov 2020Submission Checks Completed
29 Nov 2020Reviewer(s) Assigned
04 Dec 2020Review(s) Completed, Editorial Evaluation Pending
04 Dec 2020Editorial Decision: Revise Minor
06 Dec 20202nd Revision Received
10 Dec 2020Submission Checks Completed
10 Dec 2020Assigned to Editor
10 Dec 2020Review(s) Completed, Editorial Evaluation Pending
10 Dec 2020Editorial Decision: Accept
20 Dec 2020Published in Journal of Cardiac Surgery. 10.1111/jocs.15271