Is 

the Bentall Procedure the Right 
Choice in Bicuspid Aortic Valve 
Patients with Aortic Aneurysms?
Rinewalt D, Badiwala M, Malaisrie SC, Russel H, Abicht T,
Clennon C, Kruse J, Puthumana JJ, Fedak PWM, Bonow RO,
McCarthy PM.

AATS Aortic Symposium
April 24‐25th, 2014
Disclosures 

Authors have no relevant disclosures

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Bicuspid Aortic Valve Disease

• Most common congenital

heart lesion
 1-2 % of total
population

• Responsible for 50% of

aortic valve replacements
(AVR) in the United
States

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Aortopathy
• Independent risk factor: • Mechanism unknown:
 Aortic dilatation and aneurysm  Post-stenotic dilatation
formation  Degeneration of aortic media
 Dissection

Healthy volunteer age/size control RL‐BAV RN‐BAV

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Objectives 

• Address controversy regarding the extent of aortic root

replacement in patients with BAV

• Evaluate outcomes from aggressive aortic root replacement

via the Bentall procedure
 Mortality reported between 2-11%*

*Verbakel KM, et al. Results of one‐hundred and seventy patients after elective bentall operation. Asian 

cardiovascular & thoracic annals. 2012;20:418‐425.
Opotowsky AR, et al. A shifting approach to management of the thoracic aorta in bicuspid aortic valve.
Journal of Thoracic and Cardiovascular Surgery. 2013; 146: 339-346.
Methods

• Large prospective database at a single institution queried

from April 2004 to July 2013

• 679 BAV surgical patients

• 216 (32%) underwent Bentall Procedure

 Annual follow up
Patient Demographics
Age 54.3 ± 11.9

Body Mass Index 28.3 ± 4.8

Ejection Fraction 60% (median)

Ascending Aortic Diameter 46mm (median)

Gender 85% male

Diabetes 7%

Hypertension 51%

Congestive Heart Failure 14%

Repeat Sternotomy 12%
Results

• All patients underwent a Bentall Procedure

 Majority received a bioprosthetic valve (94%)
 Preference is to sew stented bovine pericardial valve into
Dacron graft

• Hemi arch replacement (42%)

• Concomittant procedures (16%)

 CABG and ablation procedures
 Results 

• Thirty day mortality =

0.46%

• Average patient follow

up 4.3 years (+/- 2.5
years)

• All-cause mortality =
5% at follow up

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Results

• Length of stay
 Median 5 days
 Mean 6.29 +/- 3.4 days
 Re-admission to ICU 1.9%

• Ventilation > 24 hours in 5.6%

• Perioperative stroke occurred in 1.9%

• 1 late re-operation for endocarditis

Conclusions 

• Bentall procedure has low perioperative morbidity and

mortality at an experienced center
 Less than 0.5% in our series

• Aggressive but safe strategy to avoid complications from

residual disease in an untreated proximal aorta.