{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T14:47:54Z","timestamp":1794322074984,"version":"4.9.0"},"reference-count":13,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T00:00:00Z","timestamp":1731974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: Type A aortic dissection (TAAD) is a life-threatening condition which requires prompt diagnosis and surgical treatment. When TAAD involves the aortic root, aortic valve-sparing or Bentall procedures are the main surgical treatment options. Method: The subjects of this analysis were 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD). Propensity score matching was performed by estimating a propensity score from being treated with the Bentall or the David procedure using multilevel mixed-effects logistics, considering the cluster effect of the participating hospitals. Results: A Bentall procedure was performed in 862 patients, while a David operation was performed in 139 patients. The proportion of aortic root replacement, as well as the different techniques of aortic root replacement, varied significantly between the participating hospitals (p &lt; 0.001). After propensity score matching, we obtained two groups of 115 patients each, and no statistical differences were reported in terms of postoperative outcomes, except for the rate of dialysis, which was higher in the patients requiring a Bentall procedure (17.4% vs. 7.0%, p-value 0.016). In the unmatched cohorts, the David procedure was associated with a lower 10-year mortality rate compared to the Bentall procedure (30.1% vs. 45.6%, p-value 0.004), but no difference was observed after matching (30.0% vs. 43.9%, p-value 0.082). After 10 years, no differences were observed in terms of proximal aortic reoperation (3.9% vs. 4.1%, p-value 0.954), even after propensity score matching (2.8% vs. 1.8%, p-value 0.994). Conclusions: The David and Bentall procedures are durable treatment methods for TAAD. When feasible, it is advisable that the David procedure is performed for acute TAAD by surgeons with experience with this demanding surgical technique.<\/jats:p>","DOI":"10.3390\/jcdd11110370","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T04:53:05Z","timestamp":1731991985000},"page":"370","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["The David Versus the Bentall Procedure for Acute Type A Aortic Dissection"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5028-8186","authenticated-orcid":false,"given":"Fausto","family":"Biancari","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Mastroiacovo","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mauro","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3722-1718","authenticated-orcid":false,"given":"Luisa","family":"Ferrante","sequence":"additional","affiliation":[{"name":"Cardiac Surgery, Molinette Hospital, University of Turin, 10126 Turin, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"M\u00e4kikallio","sequence":"additional","affiliation":[{"name":"Department of Medicine, South-Karelia Central Hospital, University of Helsinki, 53130 Lappeenranta, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatu","family":"Juvonen","sequence":"additional","affiliation":[{"name":"Heart and Lung Center, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland"},{"name":"Faculty of Medicine, University of Oulu, 90220 Oulu, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Mariscalco","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3547-7293","authenticated-orcid":false,"given":"Zein","family":"El-Dean","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Glenfield Hospital, Leicester LE3 9QP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Pettinari","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Saint Luc Hospital, 1200 Louvain, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8740-2090","authenticated-orcid":false,"given":"Javier","family":"Rodriguez Lega","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery Department, University Hospital Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angel G.","family":"Pinto","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery Department, University Hospital Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Perrotti","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, 25000 Besancon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0879-3557","authenticated-orcid":false,"given":"Francesco","family":"Onorati","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, University of Verona Medical School, 37134 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5784-5747","authenticated-orcid":false,"given":"Konrad","family":"Wisniewski","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, University Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8978-9914","authenticated-orcid":false,"given":"Till","family":"Demal","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Heart and Vascular Center of Hamburg, 20251 Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1662-5828","authenticated-orcid":false,"given":"Petr","family":"Kacer","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Charles University, 10000 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Rocek","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Charles University, 10000 Prague, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8134-0231","authenticated-orcid":false,"given":"Dario","family":"Di Perna","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, 74370 Epagny Metz-Tessy, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Vendramin","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9959-167X","authenticated-orcid":false,"given":"Daniela","family":"Piani","sequence":"additional","affiliation":[{"name":"Cardiothoracic Department, Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduard","family":"Quintana","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Hospital Cl\u00ednic de Barcelona, University of Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1872-6275","authenticated-orcid":false,"given":"Robert","family":"Pruna-Guillen","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Hospital Cl\u00ednic de Barcelona, University of Barcelona, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8749-2962","authenticated-orcid":false,"given":"Joscha","family":"Buech","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80336 Munich, Germany"},{"name":"German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0782-1456","authenticated-orcid":false,"given":"Caroline","family":"Radner","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, LMU University Hospital, Ludwig Maximilian University, 80336 Munich, Germany"},{"name":"German Centre for Cardiovascular Research, Partner Site Munich Heart Alliance, 80336 Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Kuduvalli","sequence":"additional","affiliation":[{"name":"Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amer","family":"Harky","sequence":"additional","affiliation":[{"name":"Liverpool Heart and Chest Hospital, Liverpool L14 3PE, 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Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9996-6133","authenticated-orcid":false,"given":"Giuseppe","family":"Gatti","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Cardio-Thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2237-9050","authenticated-orcid":false,"given":"Lenard","family":"Conradi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Cologne University Hospital, 50937 Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Field","sequence":"additional","affiliation":[{"name":"Liverpool Heart and Chest Hospital, Liverpool L14 3PE, 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Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e223","DOI":"10.1016\/j.jacc.2022.08.004","article-title":"2022 ACC\/AHA Guideline for the diagnosis and management of aortic disease: A report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"80","author":"Isselbacher","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1396","DOI":"10.1016\/j.athoracsur.2022.06.041","article-title":"The aortic root in acute type A dissection: Repair or replace?","volume":"115","author":"Arabkhani","year":"2023","journal-title":"Ann. Thorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1016\/j.jtcvs.2021.02.101","article-title":"Valve-sparing aortic root replacement can be done safely and effectively in acute type A aortic dissection","volume":"164","author":"Khachatryan","year":"2022","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1111\/jocs.15271","article-title":"Management of aortic root in type A dissection: Bentall approach","volume":"36","author":"Khachatryan","year":"2021","journal-title":"J. Card. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1186\/s13019-021-01536-5","article-title":"European registry of type A aortic dissection (ERTAAD)\u2014Rationale, design and definition criteria","volume":"16","author":"Biancari","year":"2021","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1016\/j.ejcts.2004.12.059","article-title":"Composite aortic root replacement in acute type A dissection: Time to rethink the indications?","volume":"27","author":"Halstead","year":"2005","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.athoracsur.2014.08.079","article-title":"Midterm results of David V valve-sparing aortic root replacement in acute type A aortic dissection","volume":"99","author":"Leshnower","year":"2015","journal-title":"Ann. Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.jtcvs.2018.10.059","article-title":"Durability and safety of David V valve-sparing root replacement in acute type A aortic dissection","volume":"157","author":"Rosenblum","year":"2019","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.athoracsur.2017.09.029","article-title":"Sixteen-Year Experience of David and Bentall procedures in acute type A aortic dissection","volume":"105","author":"Yang","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1093\/ejcts\/ezy266","article-title":"A systemic review and meta-analysis: Bentall versus David procedure in acute type A aortic dissection","volume":"55","author":"Mosbahi","year":"2019","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1016\/j.athoracsur.2013.02.039","article-title":"National outcomes in acute aortic dissection: Influence of surgeon and institutional volume on operative mortality","volume":"95","author":"Chikwe","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.jtcvs.2018.10.043","article-title":"Valve-sparing root replacement in type A dissection: Age and experience matter","volume":"157","author":"Levy","year":"2019","journal-title":"J. Thorac. Cardiovasc. Surg."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/11\/11\/370\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:34:52Z","timestamp":1760114092000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/11\/11\/370"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,19]]},"references-count":13,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcdd11110370"],"URL":"https:\/\/doi.org\/10.3390\/jcdd11110370","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,19]]}}}