{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T10:16:09Z","timestamp":1792145769945,"version":"4.4.0"},"reference-count":22,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T00:00:00Z","timestamp":1671753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Aim: To analyze early and mid-term outcomes of the Bentall operation. Methods: Two hundred and seventeen patients (mean age 65.6 \u00b1 15.9 years, males\/females 172\/45) underwent Bentall operation in a 7-year period (January 2015\u2013December 2021), on average, 30 Bentall operations occurred per year, using biological (n = 104) or mechanical (n = 113) valved conduits for the treatment of ascending aorta\u2013aortic root aneurysms. Associate procedures were performed in 58 patients (26.7%); coronary artery bypass grafting (CABG) in 35 (16%). Mean follow-up was 55.2 \u00b1 24 (median 60.2) months. Cox model analysis was used to assess risk factors, Kaplan\u2013Meier and log-rank tests were used to assess different survival rates. Results: Operative mortality was 1.38%. At 7 years, survival, freedom from cardiac death, and event-free survival were 93% \u00b1 2%, 99% \u00b1 1%, and 81% \u00b1 5%. NYHA class (p &lt; 0.0001), trans-aortic valve mean (p &lt; 0.0001) and maximum (p &lt; 0.000) gradients, left ventricular hypertrophy (p &lt; 0.05), and pulmonary arterial pressure (p = 0.002) significantly improved vs. preoperative values. Concomitant CABG during Bentall operation independently affected late outcomes (HR 1.9\u20132.3; p-values &lt; 0.05). Late survival was affected by concomitant CABG (84% \u00b1 8% vs. 95% \u00b1 2%, p = 0.04), preoperative myocardial infarction (91% \u00b1 9% vs. 97% \u00b1 2%, p = 0.02), and biological vs. mechanical prostheses valved conduits (91% \u00b1 9% vs. 95% \u00b1 3%, p = 0.02). Event-free survival also was affected by concomitant CABG (62% \u00b1 14% vs. 85% \u00b1 5%, p = 0.005) and biological prostheses (78% \u00b1 8% vs. 84% \u00b1 6%, p = 0.06). Freedom from endocarditis\u2013redo operation was 83% \u00b1 9% for biological prostheses vs. 89% \u00b1 6% for mechanical prostheses (p = 0.49). Conclusions: Low rates of operative mortality and late complications make Bentall operation the gold standard for the treatment of ascending aorta\u2013aortic root aneurysms. Coronary ischemic disease affects late outcomes. Biological prostheses should be preferred for the elderly.<\/jats:p>","DOI":"10.3390\/ijerph20010212","type":"journal-article","created":{"date-parts":[[2022,12,27]],"date-time":"2022-12-27T03:03:31Z","timestamp":1672110211000},"page":"212","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Bentall Operation: Early Surgical Results, Seven-Year Outcomes, and Risk Factors Analysis"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4005-3110","authenticated-orcid":false,"given":"Paolo","family":"Nardi","sequence":"first","affiliation":[{"name":"Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6488-1965","authenticated-orcid":false,"given":"Calogera","family":"Pisano","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3328-134X","authenticated-orcid":false,"given":"Carlo","family":"Bassano","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Bertoldo","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro Cristian","family":"Salvati","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Buioni","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Trombetti","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Asta","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattia","family":"Scognamiglio","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Altieri","sequence":"additional","affiliation":[{"name":"Cardiology Unit of the Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Ruvolo","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1136\/thx.23.4.338","article-title":"A technique for complete replacement of the ascending aorta","volume":"23","author":"Bentall","year":"1968","journal-title":"Thorax"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1016\/j.athoracsur.2018.12.039","article-title":"Elective Aortic Root Replacement in North America: Analysis of STS Adult Cardiac Surgery Database","volume":"107","author":"Wallen","year":"2019","journal-title":"Ann. Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.jtcvs.2014.05.042","article-title":"Aortic root surgery in the United States: A report from the Society of Thoracic Surgeons database","volume":"149","author":"Stamou","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.1016\/j.athoracsur.2020.03.083","article-title":"The Need for the STS Score Risk Stratification System for Aortic Root Aneurysms Surgery","volume":"110","author":"Nardi","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1684","DOI":"10.1016\/j.athoracsur.2015.10.090","article-title":"Bentall Procedure: A Systematic Review and Meta-Analysis","volume":"101","author":"Mookhoek","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1016\/j.jtcvs.2007.12.002","article-title":"Councils of the American Association for Thoracic Surgery, Society of Thoracic Surgeons, European Association for Cardio-Thoracic Surgery, Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Guidelines for reporting mortality and morbidity after cardiac valve interventions","volume":"135","author":"Akins","year":"2008","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.21037\/jtd.2018.03.67","article-title":"Cold crystalloid versus warm blood cardioplegia in patients undergoing aortic valve replacement","volume":"10","author":"Nardi","year":"2018","journal-title":"J. Thorac. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.athoracsur.2019.10.020","article-title":"Early and Late Results After David vs Bentall Procedure: A Propensity Matched Analysis","volume":"110","author":"Leontyev","year":"2019","journal-title":"Ann. Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.athoracsur.2019.11.054","article-title":"Valve-Sparing Root Replacement Versus Composite Valve Grafting in Aortic Root Dilation: A Meta-Analysis","volume":"110","author":"Elbatarny","year":"2020","journal-title":"Ann. Thorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1648","DOI":"10.1016\/j.athoracsur.2013.06.039","article-title":"Mid-term results of different surgical techniques to replace dilated ascending aorta associated with bicuspid aortic valve disease","volume":"96","author":"Nardi","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.jtcvs.2016.05.021","article-title":"Composite valve graft implantation for the treatment of aortic valve and root disease: Results in 1045 patients","volume":"152","author":"Pacini","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1016\/j.jtcvs.2015.07.015","article-title":"Contemporary outcomes of surgery for aortic root aneurysms: A propensity-matched comparison of valve-sparing and composite valve graft replacement","volume":"150","author":"Gaudino","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"764","DOI":"10.1016\/j.jtcvs.2015.10.113","article-title":"Long-term survival, valve durability, and reoperation for 4 aortic root procedures combined with ascending aorta replacement","volume":"151","author":"Svensson","year":"2015","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_14","first-page":"9","article-title":"Current indications to surgical repair of aneurysm of ascending aorta","volume":"1","author":"Nardi","year":"2016","journal-title":"J. Vasc. Endovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.athoracsur.2015.02.057","article-title":"Aortic Root Replacement With Biological Valved Conduits","volume":"100","author":"Castrovinci","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.athoracsur.2021.03.004","article-title":"Incidence, Cause, and Outcome of Reinterventions After Aortic Root Replacement","volume":"113","author":"Yamabe","year":"2021","journal-title":"Ann. Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.athoracsur.2011.07.089","article-title":"Early and Late Outcome After Aortic Root Replacement With a Mechanical Valve Prosthesis in a Series of 528 Patients","volume":"93","author":"Ozturk","year":"2012","journal-title":"Ann. Thorac. Surg."},{"key":"ref_18","first-page":"524","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"75","author":"Vahanian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1093\/ejcts\/ezaa136","article-title":"Surgery for Bentall endocarditis: Short- and midterm outcomes from a multicenter registry","volume":"58","author":"Sponga","year":"2020","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1093\/ejcts\/ezx169","article-title":"Prosthetic valve endocarditis: Predictors of early outcome of surgical therapy. A multicentric study","volume":"52","author":"Luciani","year":"2017","journal-title":"Eur. J. Cardio-Thoracic Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"867732","DOI":"10.3389\/fcvm.2022.867732","article-title":"Long Term Results of the Modified Bentall Procedure With Mechanical and Biological Composite Valve Grafts","volume":"9","author":"Werner","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1093\/ejcts\/ezx070","article-title":"Biological versus mechanical Bentall procedure for aortic root replacement: A propensity score analysis of a consecutive series of 1112 patients\u2020","volume":"52","author":"Pantaleo","year":"2017","journal-title":"Eur. J. Cardio-Thoracic Surg."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/212\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:49:10Z","timestamp":1760147350000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/1\/212"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,23]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["ijerph20010212"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20010212","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,23]]}}}