Early outcomes of the Bentall procedure after previous cardiac surgery

The study evaluates early outcomes of patients undergoing a Bentall procedure after previous cardiac surgery.
Included 473 patients with previous composite valve graft at a single institution: composite valve graft with a mechanical prosthesis (n = 256) or composite valve graft with a bioprosthesis (n = 217).
Primary outcome was 30-day mortality. Secondary outcome was a composite of major morbidity and operative mortality: stroke, renal failure, prolonged mechanical ventilation, deep sternal infection, or reoperation during the same admission.
Median age was 57 and 74% patients were male. Median time between index surgery and reoperation was 13 years. 38% underwent urgent or emergency intervention, 13% had active endocarditis/abscess, 19% had left ventricular ejection fraction less than 40%, and 55% had undergone more than 1 previous operation.
At the time of the re-operative Bentall, both coronary arteries were reimplanted directly in 77% patients, whereas 17% received at least 1 interposition graft.
Thirty-day mortality occurred in 7.8%, and 32% patients had major morbidity and operative mortality. On multivariable analysis, risk factors associated with increased 30-day mortality included older age and coronary reimplantation by a technique other than direct anastomosis.
In the largest reported cohort of aortic root replacement after previous cardiac surgery, re-operative Bentall procedure was associated with a significant operative risk. The need for complex coronary reimplantation techniques was an important factor associated with adverse perioperative events.