Valve-sparing operation versus Bentall operation: Comparison at medium-term follow-up

The valve-sparing operation has been proposed for aortic regurgitation (AR) in the setting of aortic root dilatation. This method has several advantages over the Bentall operation. Since 1994 a total of 37 patients have undergone either reimplantation of the aortic valve (12 patients) or remodeling of the aortic root (25 patients) in our institution (group R). During the same period 33 patients have had the Bentall operation (group B) as elective surgery. The mean follow-up periods were 323 days (17-1457 days) in group A and 712 days (15-1620 days) in group B. In group R seven patients had Marfan syndrome, five had aortic dissection, and three had aortitis syndrome. In group B nine patients had Marfan syndrome, two had aortic dissection, and eight had aortitis syndrome. There were no differences in preoperative New York Heart Association class or age at operation between the two groups. There was one hospital death in each group and one late death in group B. Two patients in group R required reoperation but none in group B. Actuarial survivals at 4 years were 96.7% in group R and 94.0% in group B. The event-free rates at 4 years were 94.6% in group R and 93.9% in group B. The reoperation-free rates at 4 years were 94.6% in group R and 100% in group B. There was no statistical difference between the two groups for all rates. The valve-sparing operation maintains valve competence during the early postoperative course in our experience, but follow-up data showed deterioration of the valve competence after reimplantation or remodeling, particularly when aortic regurgitation, even mild, was seen after operation. The medium-term survival and cardiac event rates for the valve-sparing operation showed no statistical difference from those of the Bentall operation, although the long-term results of valve competence after the valve-sparing operation are still not known. The aortic root replacement technique should be selected in each clinical setting.