Cardiovascular Journal of Africa: Vol 29 No 4 (July/August 2018)

43 / 76

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 29, No 4, July/August 2018 AFRICA 241
Short-term results of flanged Bentall de Bono and valve-
sparing David V procedures for the treatment of aortic
root aneurysms
Servet Ergün, Mehmet Dedemoğlu, Murat Bülent RabuŞ, Baburhan Özbek, Mustafa Mert Özgür,
Mehmet Altuğ Tuncer, Mehmet Balkanay, Mehmet Kaan Kırali
Abstract
Aim: Even though the Bentall de Bono procedure is widely
used for the treatment of aortic root aneurysms, the proce-
dure is under scrutiny nowadays because of complications
due to mechanical prosthetic valves and the need for life-long
anticoagulation. Due to these complications, aortic valve-
sparing operations are being researched. In this study we
compared the short-term morbidity and mortality rates of
both Bentall de Bono and valve-sparing David V procedures.
Methods: We retrospectively evaluated data from 70 patients
who had undergone surgery for aortic root aneurysm between
April 2009 and June 2013. We had performed the Bentall de
Bono procedure on 46 patients and the David V procedure
on 24 patients. Mortality rates, cardpulmonary bypass (CPB)
and aortic cross-clamp durations, postoperative arrhythmias,
and prolonged intensive care unit (ICU) and hospital stays
were compared in this study.
Results: There was no statistical difference for mortality rate
( p = 0.57), while the CPB time and cross-clamp duration were
shorter in the Bentall group. When we compared the length
of ICU and hospital stay, we observed that the David group
stayed longer in ICU (p = 0.003) but the duration of hospital
stay was shorter (p = 0.007).
Conclusion: Despite Bentall de Bono being the most common-
ly used procedure, the short-, mid- and long-term results of
both procedures were similar. Spared native aortic valve and
lack of anticoagulation usage are notable advantages of the
David V procedure.
Keywords: valve-sparing aortic root surgery, flanged Benthall,
David V
Submitted 24/6/16, accepted 15/3/18
Published online 26/6/18
Cardiovasc J Afr 2018; 29: 241–245
DOI: 10.5830/CVJA-2018-021
Several surgical procedures are used to repair ascending
aortic aneurysms. Factors such as feasibility, percentage of
complications, and surgical morbidity and mortality rates are
critically important in choosing the best operation strategy.
Valve-sparing procedures have some advantages, such as
not needing to use anticoagulation therapy and there are no
complications related to mechanical valves. Procedures using a
mechanical composite valved graft also have advantages, such as
long-term valve durability.1-5 There are many discussions about
which procedure is better.
The first aortic root replacement with a composite valve
graft was performed by Bentall and de Bono in 1968.6 In this
procedure, the ascending aorta and aortic valve was resected.
Firstly a mechanical prosthetic valve was sutured to a tubular
graft and then the valved graft was sutured to the aortic annulus
with continuous prolene sutures.
A flanged Bentall procedure was reported by Yakut in 2000.7
In this procedure about 5 mm of the proximal end of the graft is
everted outward. The mechanical valve is fixed to the graft with
continuous polyprolene sutures from the stent of the valve to the
graft. Then the everted part of the graft is returned to its original
position and the conduit is implanted onto the aortic annulus
from the flanged part with continuous polyprolene sutures. The
rest is the same as with the classical Bentall de Bono procedure.
Classical valve-sparing root replacement was reported by
David and Feindel in 1992. They defined their procedure as
first resecting the aortic root completely while sparing the valve,
preparing the coronary ostia in a button shape, then suturing a
dacron graft to the aortic root, and finally suturing the buttons
to the dacron graft. 8
When we assessed the complications related to long-term
risk of anticoagulation, we observed the superiority of using
homografts, pulmonary otografts, valve-sparing procedures or
bioprosthetic valved composite grafts instead of composite
grafts with mechanical valves.4-8
In this study, we evaluated the initial results of the flanged
Bentall procedure versus the David V procedure in terms of
surgical morbidity and mortality rates, and complications related
to the procedures.
Cardiovascular Surgery Department, Kars Harakani
Hospital, Kars, Turkey
Servet Ergün, MD,
Department of Pediatric Heart Surgery, Dr Siyami Ersek Training
and Research Hospital, Istanbul, Turkey
Mehmet Dedemoğlu, MD
Department of Cardiovascular Surgery, Kartal Kosuyolu
Training and Research Hospital, Istanbul, Turkey
Murat Bülent Rabuş, MD
Baburhan Özbek, MD
Mustafa Mert Özgür, MD
Mehmet Altuğ Tuncer, MD
Mehmet Kaan Kırali, MD
Department of Cardiovascular Surgery, Izmir Katip Çelebi
University, Atatürk Training and Research Hospital, Izmir,
Turkey
Mehmet Balkanay, MD