Midterm outcomes of Bentall procedure versus isolated aortic valve replacement for bicuspid aortic valve with severe stenosis and ascending aortic dilation

To compare the midterm outcomes of the Bentall procedure versus isolated aortic valve replacement (AVR) in patients with bicuspid aortic valve (BAV) complicated with severe stenosis and ascending aortic dilation in order to assess the therapeutic value of these surgical approaches for this complex cardiac condition.

A retrospective cohort study was conducted on 96 eligible patients who underwent surgical treatment in our institute between January 2018 and December 2022. According to surgical approaches, they were divided into an AVR group (65 cases) and a Bentall group (31 cases). Demographic features, comorbidities, preoperative status, and echocardiographic parameters were collected in all patients. Propensity score matching (PSM) was applied in a 1:1 ratio to balance baseline characteristics. Perioperative indicators and follow-up data were compared and analyzed between matched cohorts after control of cofounding factors.

After PSM, 25 matched pairs were screened out and analyzed with comparable baseline data (all P>0.05). The Bentall group demonstrated significantly more superior intraoperative effective orifice area (EOA, 2.69±0.47 vs 2.35±0.47 cm², P=0.013) and EOA index (EOAI, 1.69±0.30 vs 1.47±0.29 cm²/m², P=0.010), and obviously longer cardiopulmonary bypass time [190.00 (147.00, 257.00) vs 101.00 (88.50, 124.50) min, P<0.01] and aortic cross-clamp time [141.00 (120.00, 166.00) vs 66.00 (55.00, 81.50) min, P<0.01] when compared with the AVR group. During a median followup of 28 months, the AVR group had notably larger aortic sinus diameter [32.00 (30.00, 34.00) vs 26.80 (26.00, 28.00) mm, P<0.01] and ascending aortic diameter [38.00 (34.50, 42.00) mm vs 26.00 (26.00, 28.00) mm, P<0.01], with ongoing dilation in the ascending aorta, while the Bentall group maintained stable dimensions. The Bentall group also showed statistically lower peak aortic valve pressure gradients [21.00 (15.50, 27.00) vs 25.00 (19.50, 31.00) mmHg, P=0.049].

Both Bentall procedure and AVR are effective in treatment of BAV complicated with severe stenosis and ascending aortic dilation. But, Bentall procedure offers advantages in hemodynamic optimization and aortic stability.