ObjectiveTo summarize clinical experience and outcomes of modified Bentall procedure for the treatment of Stanford type A3 aortic dissection (AD). MethodsFifty-four patients with Stanford type A3 AD underwent aortic root replacement in Nanjing Hospital Affiliated to Nanjing Medical University from January 2004 to June 2013. There were 41 male and 13 female patients with their age of 21-73 years. According to different surgical methods, all the 54 patients were divided into 2 groups. In group A, there were 36 patients who received conventional Bentall procedure. In group B, there were 18 patients who received modified Bentall procedure ('gate' anastomosis of the coronary ostia for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia). Postoperative outcomes were compared between the 2 groups. ResultsThere was no statistical difference in age or gender between the 2 groups. Mean diameter of the aortic root of group A was significantly larger than that of group B (52.11±3.62 mm vs. 40.72±2.67 mm, P=0.000). There was no statistical difference in operation time, cardiopulmonary bypass time, intraoperative circulation arrest time, postoperative thoracic drainage or length of ICU stay between the 2 groups (P > 0.05). Four patients died postoperatively including 2 patients with uncontrollable bleeding, 1 patient with abdominal AD rupture and 1 patient with acute pulmonary embolism. There was no statistical difference in in-hospital mortality between group A and group B[5.56% (2/36)vs. 11.11% (2/18), P=0.462]. Forty-eight patients were followed up for 3 months, and 2 patients were lost during follow-up. Forty-eight patients received computed tomography angiography without false aneurysm formation in the aortic root, coronary ostial aneurysm or stenosis. ConclusionModified Bentall procedure ('gate' anastomosis of the coronary ostia)is simple and effective for patients with aortic root less than 45 mm and nonsignificant displacement of the coronary ostia.
Objective To study the mid-term and long-term postoperative results of Bentall procedure in patients with Marfan syndrome. Methods From February 2009 to July 2016, ten adolescent patients (mean age of 12.30±2.31 years ranged 9-16 years, mean height of 172.50±12.55 mm, mean weight of 48.60±17.08 kg) underwent Bentall procedure in our hospital. All these teenage patients were with Marfan syndrome, 6 boys and 4 girls. Five of them underwent mitral valve replacement procedure at the same time while 2 of them with tricuspid valvuloplasty. Results No mortality was found in hospitalization. One patient suffered respiratory failure after surgery. No renal failure, mediastinal infection or re-operation caused by bleeding were observed. All were well followed up for 62 months. One died of malignant arrhythmia, the other were in good condition with the latest interview. Conclusion Teenage patients with Marfan syndrome who underwent Bentall procedure have favorable outcomes in mid-term and long-term follow-up, they probably will not suffer anti-coagulation complications and restriction of growth.
ObjectiveTo evaluate the short-term results of sleeve wrapping technique using remnant aortic wall in modified Bentall procedure. MethodsThe patients undergoing modified Bentall procedure with the remnant aortic wall as a sleeve to cover the sewing area of composite valved graft and the aortic annulus for proximal hemostasis between March 2021 and March 2022 in Shenzhen Fuwai Hospital were enrolled. Short-term results were assessed by cardiopulmonary bypass time, aortic clamping time, mechanical ventilation time, ICU stay, postoperative hospital stay, effusion drainage on the first postoperative day, left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDD), and follow-up results. ResultsA total of 14 patients were collected, including 12 males and 2 females, with a mean age of 55.33±10.57 years. There was no postoperative or follow-up death. Cardiopulmonary bypass time was 147.90±21.29 min, aortic clamping time was 115.70±15.23 min, mechanical ventilation time was 19.42±8.98 h, ICU stay was 99.08±49.42 h, and postoperative hospital stay was 16.33±2.74 d. Thoracic drainage volume was 333.33±91.98 mL on the first postoperative day. Only 2 patients required blood transfusion (4.5 U and 2 U, respectively). During the follow-up of 6.17±3.69 months, there was no death, no aortic or valve-related complications. There was statistical difference in the LVEDD between preoperation and before discharge after surgery (P＜0.001), and between half a year after surgery and before discharge after surgery (P＜0.001). There was a little decrease of LVEF before discharge after surgery compared with preoperative LVEF, but there was no statistical difference (P=0.219). There was no statistical difference in the LVEF half a year after operation compared with that before operation (P=1.000). Conclusion Sleeve wrapping technique using remnant aortic wall in modified Bentall procedure has good short-term results. This modification may be a simple, effective way in controlling proximal bleeding.