Long-term outcomes after bentall-de bono versus modified bentall-de bono procedures: a propensity score-matched analysis

OBJECTIVE: To evaluate the impact of Bentall-de Bono (BD) versus modified Bentall-de Bono (MBD) procedures on patient survival and long-term clinical outcomes. METHODS: We reviewed 1,478 patients who underwent Bentall procedures between 2003 and 2022. Patients were initially stratified into two groups based on surgical technique: the BD group (n = 1,274), and the MBD group (n = 204). To mitigate baseline imbalances and selection bias, a 1:1 propensity score matching analysis was performed, yielding 202 matched pairs. Long-term survival was assessed using Kaplan-Meier analysis. Stroke was analyzed as an exploratory secondary cerebrovascular outcome. Predictors of mortality were identified via multivariable Cox proportional hazards regression. RESULTS: In the matched cohort, the median follow-up was 5.98 (interquartile range: 3.53-9.84) years. Kaplan-Meier analysis demonstrated comparable 10-year survival rates between the BD and MBD groups (90.9% vs. 88.4%, P = 0.42). Freedom from stroke was evaluated exploratorily and did not differ significantly between groups. (80.0% vs. 80.2%, P = 0.63). Multivariable Cox regression confirmed that the surgical technique (BD vs. MBD) was not an independent predictor of long-term mortality (hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.40-1.74; P = 0.634). Independent predictors of late mortality included advanced age and prolonged aortic cross-clamp time. CONCLUSION: There is no difference in long-term survival following BD versus MBD.