Original Article

Asian Cardiovascular & Thoracic Annals

20(4) 418–425
ß The Author(s) 2012
Results of one-hundred and seventy Reprints and permissions:
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patients after elective Bentall operation DOI: 10.1177/0218492312439057
aan.sagepub.com

Karin MJ Verbakel, Albert HM van Straten, Mohamed

A Soliman Hamad, Erwin SH Tan and Joost F ter Woorst

Abstract
The aim of this study was to evaluate the short and long-term operative results of patients who underwent a Bentall
procedure in a 12-year period. We retrospectively analyzed the data of 170 patients who underwent an elective Bentall
procedure between January 1998 and July 2010. All pre- and perioperative variable were entered into a multivariate
regression model to identify significant predictors of early and late mortality. The early mortality rate was 11.2% (19/170
patients). Multivariate logistic regression analysis identified prior cardiac operation and cardiopulmonary bypass time as
independent risk factors for early mortality, with odds ratios of 5.75 (95% confidence interval: 1.850–17.874; p = 0.003)
and 1.011 (95% confidence interval: 1.003–1.019; p = 0.008), respectively. The Kaplan-Meier curve shows an overall
survival of 78%  4% at 5 years and 66%  10% at 10 years. Cox regression analysis revealed no independent risk factors
for late mortality. The Bentall procedure is still the procedure of choice for aortic root replacement. Improvements in
perioperative management in recent years has improved the early outcome, and in our experience, the late results of this
technique were satisfactory.

Keywords
Aneurysm, dissecting, aorta, aortic aneurysm, blood vessel prosthesis implantation, survival rate

Introduction
The Bentall procedure, first described by Bentall and
De Bono1 in 1968 (and the later modified ‘‘button’’
Bentall described by Kouchoukos and colleagues2)
has become the procedure of choice for a variety of
aortic root disorders. The indications for a Bentall pro-
cedure can be divided into 2 categories: urgent and elec-
tive. Urgent situations include acute type A aortic
dissection with aortic valve pathology. Another
urgent indication is prosthetic graft infection or aortic
valve endocarditis with abscess formation. Some exam-
ples of elective indications are annuloaortic ectasia with
aortic valve incompetence, Marfan’s syndrome pathol-
ogy, post-stenotic dilatation, and chronic dissection of
the ascending aorta.3–5 Although excellent results after
elective indications have been reported, depending on
the different aortic pathologies, the mortality and mor-
bidity rates vary greatly in recent literature.6–9 This var-
iation is possibly due to different patient populations,
operative techniques, and postoperative management.10
In this retrospective study, we investigated our results
of the Bentall procedure over the last 12 years. Our aim
is to evaluate early and late results of this technique and
to identify the influence of preoperative and periopera-
tive variables on the outcome.
Patients and methods
All patients undergoing an elective modified button
Bentall procedure in the Department of Cardiothoracic
Surgery, Catharina Hospital, Eindhoven, The Nether-
lands, between January 1998 and July 2010, were
included in this study. The patients were identified
from a computerized cardiac surgery database.
Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven,
The Netherlands
Corresponding author:
Mohamed A Soliman Hamad, MD, PhD, Department of Cardiothoracic
Surgery, Catharina Hospital, Michelangelolaan 2, Postbus 1350, 5602 ZA
Eindhoven, The Netherlands.
Email: aasmsn@cze.nl

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Verbakel et al. 419

The data from hospital charts, operative reports, blood aneurysm. Venous return was established via single
management charts, and clinical follow-up notes were right atrial cannulation, bicaval cannulation through
evaluated retrospectively. The study was approved by the right atrium, or femoral vein and right atrial supe-
the local medical ethical review committee which rior vena caval cannulation. After aortic crossclamping,
waived the need for informed consent. During this
period of 12 years, 170 patients underwent an elective
Bentall procedure; 128 (75.3%) were operated on in
2004 or later. Aneurysm of the ascending aorta, with Table 2. Operative and early postoperative data.
(43.4%) or without (56.6%) a bicuspid aortic valve,
Variable Value
was the most common indication for operation. The
preoperative patient characteristics are summarized in Aortic crossclamp time 105.1  34.5
Table 1. (min) [range] [54–243]
All patients underwent a median sternotomy. Cardiopulmonary bypass 154.9  59.8
Extracorporeal circulation was established by inserting time (min) [range] [75–346]
an arterial cannula either through the femoral artery or Cardioplegia
into the aortic arch, depending on the presence of aortic Cold crystalloid cardioplegia 139 (81.8%)
dissection or extension of the ascending aortic Blood cardioplegia 31 (18.2%)
Temperature >25  C 158 (92.9%)
Circulatory arrest (min) 12 (7.1%)
Cerebral protection technique
Table 1. Preoperative patient characteristics. Antegrade cerebral perfusion 2 (1.2%)
Characteristics Value Retrograde cerebral perfusion 3 (1.8%)
Deep hypothermic arrest 7 (4.1%)
Male sex 119 (70%) Intraaortic balloon pump
Age (years) 60.5  12.5 Type of aortic valve 13 (7.6%)
Operation indication Mechanical 118 (69.4%)
Annuloaortic ectasia 29 (17.1%) Bioprosthesis 52 (30.6%)
Type A aortic dissection 6 (3.5%) Vascular prosthesis 11 (6.5%)
Poststenotic dilatation 6 (3.5%) Concomitant procedures 60 (35.3%)
Aneurysm of ascending aorta 122 (71.8%) Hospital stay (days) [range] 13.9  12.5 [1-98]
(median, 10.0)
Without bicuspid aortic valve 69 (56.6%)
Intensive care unit stay 5.1  9.7 [0-97]
With bicuspid aortic valve 53 (43.4%) (days) [range] (median, 2.0)
Porcelain aorta 1 (0.6%) Prolonged respiratory 18 (10.6%)
Miscellaneous 6 (3.5%) support >48 h
Year of operation <2004 42 (24.7%) Reexploration for any cause 25 (14.7%)
NYHA classification 1.53  0.78 Early reoperation 38 (22.4%)
For bleeding 14 (36.8%)
LVEF <50% 40 (23.5%)
For tamponade 7 (18.4%)
Marfan’s syndrome 7 (4.1%)
For gauze removal 3 (8%)
Endocarditis 5 (2.9%)
Other 14 (36.8%)
Hypertension 91 (53.5%) Perioperative myocardial 13 (7.6%)
Associated coronary artery disease 35 (20.6%) infarction
History of myocardial infarction 16 (9.4%) Perioperative ventricle 3 (1.8%)
Smoking 32 (18.8%) fibrillation
COPD 26 (15.3%) Pneumothorax 3 (1.8%)
Cerebral vascular accident 84.7%
Diabetes 16 (9.4%)
Acute renal failure 5 (2.9%)
Renal insufficiency 8 (4.7%)
Fever 42 (24.7%)
Cerebrovascular accident 14 (8.2%)
Mediastinitis 8 (4.7%)
Aortic valve stenosis 69 (40.6%) Infection other than
Preoperative congestive heart failure 45 (26.5%) wound infection 11 (5.9%)
Prior cardiac operation 19 (11.2%) Pneumonia 9 (81.8%)
Sepsis 2 (18.2%)
Results are expressed in number (percentages) or mean  standard
deviation. COPD: chronic obstructive pulmonary disease; LVEF: Left Data are presented in number (percentages) or mean  standard
ventricular ejection fraction; NYHA: New York Heart Association. deviation.

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420 Asian Cardiovascular & Thoracic Annals 20(4)

Table 3. Preoperative predictors of early mortality by logistic regression analyses.

Univariate analysis Multivariate analysis

Variables OR (95% CI) p value OR (95% CI) p value

Prior cardiac operation 6.757 (2.242–20.360) 0.001 5.750 (1.850–17.874) 0.003

COPD 2.211 (0.721–6.778) 0.165
Associated coronary disease 1.942 (0.680–5.541) 0.215
Aortic valve stenosis 1.733 (0.665–4.516) 0.261
Hypertension 1.562 (0.583–4.185) 0.375
Year of operation <2004 1.474 (0.523–4.160) 0.463
Preoperative stroke 1.363 (0.281–6.612) 0.701
NYHA class 53 1.161 (0.311–4.330) 0.824
Age* 1.009 (0.970–1.049) 0.666
Male sex 0.590 (0.186–1.874) 0.371
LVEF <50% 0.578 (0.159–2.094) 0.404
Diabetes mellitus 0.504 (0.063–4.044) 0.519
Aneurysm ascending aorta 0.303 (0.114–0.801) 0.016 0.363 (0.131–1.005) 0.051
Preoperative renal failure 0.000 (0.000–. . .) 0.999
*Entered as a continuous variable in years. COPD: chronic obstructive pulmonary disease; CI: confidence interval; LVEF: left ventricular ejection
fraction; NYHA: New York Heart Association; OR: odds ratio.

Table 4. Operative and perioperative predictors of early mortality logistic regression analyses.

Univariate analysis Multivariate analysis

Variables OR (95% CI) p value OR (95% CI) p value

Postoperative renal failure 5.804 (0.905–37.218) 0.064

Concomitant CABG 3.630 (1.355–9.723) 0.01 1.848 (0.602–5.676) 0.283
Reexploration 3.206 (1.089–9.445) 0.035 2.549 (0.779–8.339) 0.122
Circulatory arrest 2.958 (0.726–12.059) 0.130
Cold crystalloid cardioplegia 2.326 (0.807–6.702) 0.118
Perioperative MI 1.497 (0.306–7.332) 0.618
Postoperative stroke 1.143 (0.133–9.829) 0.903
Aortic crossclamp time* 1.020 (1.007–1.033) 0.002
Cardiopulmonary bypass time* 1.012 (1.005–1.020) 0.001 1.011 (1.003–1.019) 0.008
Temperature <25  C 0.338 (0.083–1.378) 0.13
*Entered as a continuous variable in minutes. CABG: coronary artery bypass grafting; CI: confidence interval; MI: myocardial infarction; OR: odds ratio.

intermittent cold crystalloid or intermittent warm
blood cardioplegia was administered directly into the
coronary ostia to induce and maintain cardioplegic car-
diac arrest, according to the surgeon’s preference. In
cases of aortic dissection, the proximal and distal anas-
tomosis were re-approximated with felt patches, and
reinforced with BioGlue surgical adhesive (CryoLife,
Inc.). A mechanical valve was used in 118 (69.4%)
patients, and 52 (30.6%) received a biological aortic
valve. The most frequently used mechanical grafts
were the Carbo-Seal Valsalva (Carbomedics, Inc., TX,
USA) composite graft (in 41.8%) and the St. Jude
Medical (St. Jude Medical, Inc., Minnesota, MN
USA) composite graft (in 25.3%). The Biovalsalva
(Terumo Vascutek, Renfrewshire, Scotland, UK) and
the Shelhigh aortic valved conduit (Shelhigh, Inc.,
Union, New Jersey, USA) were the most often used
biological composite grafts (in 17.1% and 6.5% of
patients, respectively).
Mortality and morbidity data were collected until
July 2010. Operative data were available for all
patients. All survivors returned to our outpatient
clinic 6 weeks postoperatively for a routine physical
examination and transthoracic echocardiography.
Afterwards, patients were followed by their own cardi-
ologist with transthoracic echocardiography and/or
computed tomography of the aortic root on a yearly
basis. Late follow-up data were collected by

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Verbakel et al. 421

Table 5. Late mortality and long-term events. Table 6. Preoperative predictors of late mortality by univariate
Cox regression analysis.
Characteristics No. of patients
Univariate analysis
Died 17 (10%) Variables OR (95% CI) p value
Late mortality
Myocardial ischemia 2 (11.7%) Preoperative renal failure 4.707 (1.317–16.825) 0.017
Aorta aneurysm rupture 1 (5.9%) Preoperative stroke 3.315 (0.932–11.797) 0.064
Cardiac failure 7 (41.2%) COPD 2.400 (0.764–7.543) 0.134
Sepsis 1 (5.9%) Hypertension 1.716 (0.632–4.658) 0.289
Necrotizing pancreatitis 1 (5.9%) Associated coronary disease 1.644 (0.572–4.721) 0.356
Morphine intoxication 1 (5.9%) Male sex 1.334 (0.493–3.609) 0.571
Unknown 4 (23.5%) Year of operation <2004 1.294 (0.442–3.789) 0.639
Late Reoperation 24 (14.1%) Aneurysm ascending aorta 1.129 (0.320–3.983) 0.850
For endocarditis 2 (8.3%) Age* 1.041 (0.994–1.091) 0.089
For ascending aorta aneurysm 2 (8.3%) NYHA class 53 0.677 (0.153–2.999) 0.608
For type A dissection 1 (4.2%) Prior cardiac operation 0.586 (0.077–4.436) 0.605
For paravalvular leakage 1 (4.2%) LVEF <50% 0.422 (0.096–1.850) 0.253
Other 18 (75%) Aortic valve stenosis 0.351 (0.101–1.222) 0.100
Congestive heart failure 31 (18.2%) Diabetes mellitus 0.038 (0.000–22.926) 0.317
Arrhythmia 38 (22.4%) *Entered as a continuous variable in years. CI: confidence
Pacemaker/defibrillator implantation 18 (10.6%) interval; COPD: chronic obstructive pulmonary disease; LVEF: left
Prosthetic valve endocarditis 2 (1.2%) ventricular ejection fraction; NYHA: New York Heart Association; OR:
Pulmonary embolism/deep vein thrombosis 2 (1.2%) odds ratio.

echocardiography and computed tomography reports
from the referring cardiologist, and hospital charts.
Postoperative complications were analyzed according
to the Guidelines for Reporting Mortality and
Morbidity After Cardiac Valve Interventions.10
All statistical analyses were performed using SPSS
version 17.0 (SPSS, Inc., Chicago, IL, USA).
Significance between categorical variables was calcu-
lated with the chi-squared or Fisher’s exact test, and
reported in percentages. Continuous variables were
compared using the unpaired t test and are reported
as mean  standard deviation. Correlation between
variables was estimated with bivariate Pearson’s cor-
relation analysis. Univariate and multivariate logistic
regression analyses were carried out to evaluate pre-
dictors of early mortality. Univariate and multivari-
ate Cox proportional hazard regression analyses
were undertaken to identify the predictors of early
and late mortality. Only variables that were signifi-
cant in the univariate analysis were entered in the
multivariate analysis. Late survival rates (including
early mortality) were determined by Kaplan-Meier
survival analysis. A p value less than 0.05 was con-
sidered to be significant.
Results
The early mortality rate was 11.2% (19 of 170 patients).
Six (3.5%) patients died intraoperatively. Early
death was mainly attributed to low cardiac output in
12 patients, persistent ventricular arrhythmia in 2, hem-
orrhage in one, and 3 patients died from other causes.
Reexploration for bleeding, cardiac tamponade or
gauze removal was needed in 25 (14.7%) patients.
Eighteen (10.6%) patients needed prolonged respira-
tory support. Other observed complications were post-
operative infection including wound infection,
pneumonia, and sepsis in 19 (11.2%) patients, periop-
erative myocardial infarction in 13 (7.6%), postopera-
tive stroke in 8 (4.7%), and acute renal failure in 5
(2.9%). Table 2 shows the important operative and
early postoperative data. On univariate analysis of pre-
operative variables (Table 3), aneurysm of the ascend-
ing aorta and a prior cardiac operation were found to
be significant predictors of early mortality. Multivariate
logistic regression analysis identified a prior cardiac
operation as the only independent risk factor for early
mortality. Considering operative and perioperative var-
iables (Table 4), univariate analysis showed that aortic
cross clamp time, cardiopulmonary bypass time, con-
comitant coronary artery bypass grafting, and re-
exploration were significant risk factors for early
mortality. However, the multivariate regression analy-
sis identified only cardiopulmonary bypass time as an
independent risk factor for early mortality. Because of
a Pearson correlation of 0.780 between aortic cross
clamp time and cardiopulmonary bypass time, the
aortic cross clamp time was excluded in the multivariate
regression analysis. When the early mortality of the
Bentall procedures in the first half of the study period

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422 Asian Cardiovascular & Thoracic Annals 20(4)

(1998–2003) was compared with that in the second half a mean interval of 2.9  3.1 years (range, 0–12 years;
(2004–2010), the incidence of early mortality decreased median, 2 years) after the operation. During follow-
from 14.3% in the first half to 10.2% in the second half. up, 2 patients developed prosthetic valve endocarditis
Late results are summarized in Table 5. Follow-up at 2 months and at 2 years after surgery. Five patients
data were available for 139 of 151 hospital survivors at required a new intervention, one for new acute aortic
dissection, one for paravalvular leakage, and 3 for a
Table 7. Operative and perioperative predictors of late
new aneurysm in the aortic arch. During long-term
mortality by univariate Cox regression analyses. follow-up, 17 (11.3%) of the 151 hospital survivors
died. Late death was due to cardiac failure in 7 patients,
Univariate analysis myocardial ischemia in 2, ruptured thoracic aortic aneu-
Variables OR (95% CI) p value rysm in 1, and other causes in 7. The most frequent late
Reexploration for any 2.524 (0.814–7.830) 0.109 morbidities were cardiac failure in 31 (18.2%) of 151
cause patients and arrhythmia in 38/151 (22.4%). Mainly
Perioperative myocardial 2.169 (0.609–7.718) 0.232 due to these complications, 18 (10.6%) patients were
infarction given a permanent pacemaker or implantable cardiover-
Circulatory arrest 1.953 (0.497–7.668) 0.337 ter defibrillator. Univariate analysis of preoperative var-
Cold crystalloid 1.550 (0.535–4.491) 0.420 iables (Table 6) showed a significant association only
cardioplegia between late mortality and preoperative renal failure.
Postoperative stroke 1.343 (0.175–10.277) 0.777 Analysis of operative and perioperative variables
(Table 7) identified aortic crossclamp time and cardio-
Concomitant CABG 1.035 (0.331–3.235) 0.952
pulmonary bypass time as predictors of late mortality.
Aortic crossclamp time* 1.014 (1.004–1.025) 0.005
Because of the existing Pearson correlation between
Cardiopulmonary 1.008 (1.002–1.015) 0.014 aortic crossclamp time and the cardiopulmonary
bypass time*
bypass time, Cox multivariate analysis was not
Temperature <25  C 0.512 (0.130–2.010) 0.337 executed. The Kaplan-Meier survival curve for all 170
Postoperative renal failure 0.048 (0.000–40,437.0) 0.689 patients undergoing a Bentall procedure is shown in
*Entered as a continuous variable in minutes. CABG: coronary artery Figure 1. The survival rates at 30 days, 1, 5, and 10
bypass grafting; CI: confidence interval; OR: odds ratio. years were: 88%  2% (n = 151), 84%  3% (n = 120),

Figure 1. Overall survival after a Bentall procedure: Kaplan-Meier survival curve of all patients, including early mortality
(percentage  standard error).

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Verbakel et al.
78%  4% (n = 41), and 66%  10%
respectively.
Discussion
This study confirms the effectiveness and durability of
the Bentall procedure in the treatment of aortic root
pathology. Using uni- and multivariate logistic regres-
sion analysis, we identified a prior cardiac operation
and the cardiopulmonary bypass time as independent
risk factors for early mortality.
Composite valve graft replacement, known as the
Bentall procedure, has been widely accepted as the pre-
ferred treatment for aneurysms or dissections involving
the aortic root.2 Over the last decades, there has been a
considerable improvement in mortality rates after this
procedure.4,11 In this retrospective analysis of 170 con-
secutive patients undergoing an elective Bentall proce-
dure, the rate of early mortality was 11.2%. Schachner
and colleagues12 reported a hospital mortality of 12%
in 74 patients undergoing the Bentall procedure. Zehr
and colleagues13 evaluated 203 patients who underwent
elective or urgent aortic root surgery for an aortic root
aneurysm, and reported an early mortality rate of
4.0%. On the other hand, Hagl and colleagues9
reported an early mortality rate of 0.7% in 142 elective
patients undergoing a Bentall procedure. Their patient
population excluded patients older than 65 years and
those undergoing a concomitant procedure. This can
possibly explain the low mortality in their patients.
Comparison among different series in the literature,
regarding the incidence of early mortality after the
Bentall operation, is often difficult. Discrepancy
among reports could be explained by variations in
aortic root pathology, different patient populations,
as well as operative and perioperative management
techniques.14 Even in the same centre, the incidence
of hospital mortality after this procedure could differ
over time. We compared the early mortality of the
Bentall procedure in the first half of the study period
(1998–2003) with that in the second half (2004–2010).
The incidence of early mortality decreased from 14.3%
in the first half to 10.2% in the second half, but this
difference did not reach significance, possibly due to the
relatively small number of patients in both cohorts (42
vs. 128). However, it indicates a trend towards a
decrease in early mortality during the 12-year study
period. Since 2004, aortic root surgery in our center
has been performed by a limited number of surgeons.
Moreover, fixed operative and perioperative protocols
have been applied. Before 2004, operative techniques
differed according to the surgeon’s preference. We
agree with other reports that refinement of operative
techniques and advances in management of anesthesia,
cardiopulmonary bypass, and myocardial protection,
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423
(n = 8), as well as early surgical intervention have contributed
to the improved results of this procedure.4,5,13
In the literature, the Bentall procedure is associated
with a high incidence of postoperative complications;
namely, bleeding and neurological complications.12 In
our study, the incidence of reexploration (for any
reason) was 14.7% and that of stroke was 4.7%.
Again, different incidences of postoperative complica-
tions have been reported. Hagl and colleagues9
reported an incidence of 1.4% for reexploration for
bleeding and 1.4% for postoperative stroke. Zehr and
colleagues 13 reported a reexploration for bleeding rate
of 4% and a stroke rate of 1.0%. Variations among
studies exist concerning the complexity of associated
procedures and the severity of preoperative comorbid-
ities (carotid vascular disease, diabetes or previous cere-
brovascular accident). This variation could account for
different incidences of postoperative complications.
Among the preoperative variables that were entered
into the univariate analysis, aneurysm of the ascending
aorta and a prior cardiac operation were associated
with an increased early mortality rate. Significant peri-
operative risk factors for early mortality were aortic
crossclamp time, cardiopulmonary bypass time, con-
comitant coronary artery bypass grafting, and reex-
ploration for any reason. When these factors were
entered in our multivariate logistic regression model,
a prior cardiac operation and the cardiopulmonary
bypass time were identified as independent risk factors
for early mortality. The lack of significance concerning
other factors could be attributed to the relatively small
study population. Reoperation was also associated with
higher early mortality using univariate analysis in the
study of Prifti and colleagues.15 Other factors identified
in their study were age > 65 years, aortic dissection,
functional class, ejection fraction 4 35%, and emer-
gency or urgency status. In a recent report by Luciani
and colleagues,16 the incidence of early mortality was
12% in patients undergoing reoperation on the aortic
root. We excluded patients who underwent an emer-
gency operation from the analysis. We believe that
these patients must be studied as a separate category
because their preoperative hemodynamic status is usu-
ally poor and often negatively influences the outcome.
Concerning the predictive value of reoperation for early
mortality, others have reported similar results.17,18
The long-term survival in our study was 78%  4%
at 5 years and 66%  10% at 10 years. These rates are
comparable with similar studies, although there are rel-
atively few reports of the long-term outcome of this
procedure. Schachner and colleagues12 reported a sur-
vival rate of 75% at 5 years. Pacini and colleagues17
evaluated 274 patients who underwent composite graft
replacement of the aortic root for annuloaortic ectasia
and aortic dissection, and reported actuarial survival of
424
77.7% at 5 years and 63% at 10 years. In contrast,
Gelsomino and colleagues14 evaluated the Bentall pro-
cedure in 72 patients with annuloaortic ectasia as the
most frequent cause of aortic disease, and reported a
mean 16-year survival rate of 91.7%  3.2%. Zehr and
colleagues13 reported actuarial survival at 5 and 10
years respectively of 93% and 79%. The obvious
discrepancy among reports regarding the long-term
survival is due to the considerable differences in preop-
erative aortic pathology in different study
populations.14,15
An important complication of the Bentall procedure
is pseudoaneurysm formation at the suture lines. Also,
the button technique is more time-consuming, and
mobilization of the coronary ostia may be associated
with a risk of damage to the buttons or some early
collaterals, as well as the risk of occlusion of the ostia
due to tension and/or kinking.2,4 Follow-up of our
patients showed that no reoperations were necessary
for the management of coronary anastomotic compli-
cations, and late echocardiograms have demonstrated
no anastomotic pseudoaneurysms. The patients who
suffered myocardial infarctions or died of coronary
artery disease did not do so as a consequence of prob-
lems with the button anastomosis. The incidence of
prosthesis-related reoperation was low. Two (1.2%)
patients developed endocarditis. In other series, the
incidence of endocarditis ranged from 0 to
2.8%.9,13–17 Univariate analysis showed a significant
association between late mortality and preoperative
renal failure, aortic crossclamp time, and cardiopulmo-
nary bypass time. These results confirm the findings of
previous reports.12,14
This was a retrospective study over a 12-year period.
During this time interval, many factors have changed.
These changes were not accounted for in the statistical
analyses. In addition, all statistical analyses are based
on a small number of patients. The endpoint of the
study was all-cause mortality, but we were not able to
retrieve some causes of late death that might have been
be equally important. However, our findings confirm
that the Bentall procedure still represents the procedure
of choice for aortic root replacement with coronary
reimplantation. Improvement of perioperative manage-
ment in recent years has improved the early outcome,
and in our experience, the late results of this technique
were satisfactory.
Funding
This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors.
Conflicts of interest statement
None declared.
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Asian Cardiovascular & Thoracic Annals 20(4)
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