Mechanical Bentall versus reimplantation for aortic root replacement: A prospective cohort study

Objective To assess early and mid - term outcomes of two aortic root surgeries for aortic regurgitation with aortic root/ascending aortic aneurysm. Methods To evaluate the pros and cons of the two procedures, prospective inclusion commenced in March 2020. From March 2020 to March 2024, 626 patients <70 years old had elective aortic root surgery. There were 252 in the reimplantation group and 374 in the mechanical Bentall group. Propensity score corrected imbalanced variables. Mean follow - up was 27 months (11 - 40 months). Intra - operative and clinical outcomes were analyzed. Results Although the reimplantation group had longer durations of aortic cross clamp (ACC) and cardiopulmonary bypass (CPB), postoperative complications did not significantly differ between the groups. During the follow - up period, the reimplantation group had a 100% survival rate, while the mechanical Bentall group had a survival rate of 98.66% (5 deaths out of 374 patients). There was 1 case of hemoptysis (0.40%) in the reimplantation group, and 13 cases (3.48%) of bleeding or thrombosis - related events in the mechanical Bentall group. After taking into account clinical covariates, mechanical Bentall procedures showed a higher risk of anticoagulant - related hemorrhage (HR 0.13; p = 0.0045) compared to reimplantation procedures. Conclusions For patients with aortic root aneurysm and normal or nearly - normal aortic valve cusps, especially those who want to avoid long - term anticoagulation, valve - sparing root reimplantation can be considered a preferred surgical option.