Mid-term results of Biological Bentall using a larger valve implantation technique.

The present study evaluated our modified technique for placing a valve one size larger for Biological Bentall (Bio-Bentall) with a stented valve using a double sawing ring technique with a comparison to classical Bio-Bentall with a stent-less valve. Between December 2001 and July 2017, 44 patients (10 stent-less and 34 stented) with Bio-Bentall were included in this study. The early and mid-term surgical outcomes and re-operation free rates, including the structural valve deterioration (SVD) rate, were investigated. The mean follow-up duration was 69 months. There were two in-hospital mortalities in the stent-less group and one in the stented group, showing no significant difference. The survival at 1, 5 and 10 years was 80%, 50% and 30% in the stent-less group and 85%, 77% and 71% in the stented group, respectively, with a significant difference. There were no cases of SVD occurrence in either group. Freedom from re-operation at 1, 5 and 10 years was 100% at all points in the stent-less group and 100%, 96% and 96% in the stented group, respectively, without significance. The mean pressure gradient through the aortic valve according to the most recent echocardiogram was 8.1 mmHg in the stent-less group and 15.8 mmHg in the stented group, without significance. Our modified technique for Bio-Bentall showed a feasible short- and mid-term survival compared to classical stent-less Bio-Bentall. Both techniques had a good outcome concerning SVD occurrence and the re-operation-free rate with a low-pressure gradient in the aortic position.