Bentall Procedure in Patients With Aortic Valve Stenosis and Root Aneurysm: A 10‐Year Single‐Center Experience

Objectives Aortic stenosis (AS) in patients undergoing the Bentall procedure for aortic root aneurysm is less frequent than aortic regurgitation (AR) and represents a distinct clinical entity with a higher prevalence of comorbidities, including coronary artery disease. This study examined whether the predominant aortic valve pathology influences outcomes after the Bentall procedure. Methods From 2015 to 2025, 442 patients who underwent elective Bentall procedures were retrospectively reviewed after predefined exclusions. Patients were stratified according to predominant aortic valve pathology into an AS group ( n = 90) and an AR group ( n = 352). Perioperative outcomes, early and late complications, freedom from reoperation, and long‐term survival were evaluated. Results Patients in the AS group were older than those in the AR group and had a higher proportion of female patients, resulting in a higher EuroSCORE II, while other baseline characteristics were comparable. The incidence of major perioperative complications was comparable between groups, and overall 30‐day mortality was 3%, with no significant difference between the AS and AR groups (5.4% vs. 2.5%, p = 0.26). During a mean follow‐up of 53 months (1858 patient‐years), overall survival was significantly lower in the AS group compared with the AR group (10 year survival: 76% vs. 87%, p < 0.001). Freedom from reoperation and long‐term complications, including stroke and endocarditis, were similar between groups. Conclusions Patient comorbidities, perioperative complications, and surgery‐related technical factors, rather than the type of aortic valve disease, are the main determinants of outcomes after Bentall procedures.