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Page 2 of 11 Perezgrovas-Olaria et al. Vessel Plus 2023;7:10 https://dx.doi.org/10.20517/2574-1209.2022.54

[HR] 1.06, 95% confidence interval [CI: 1.04-1.08], P < 0.01), chronic obstructive pulmonary disease (HR 1.63,
95%CI: [1.01-2.64], P = 0.04), preoperative renal dysfunction (HR 3.08, 95%CI: [1.98-4.78], P < 0.001), New York
Heart Association Class III/IV (HR 1.48, 95%CI: [1.04-2.10], P = 0.031), and mCVG (HR 2.15, 95%CI: [1.42-3.26],
P < 0.001) were associated with higher risk of follow-up mortality. After propensity matching, the differences in
mortality and reoperation remained significant.

Conclusions: The Bentall-De Bono operation can be performed with consistently good results in experienced
centers. Early outcomes are excellent regardless of the valve choice. In our study, the Bentall-De Bono operation
with bCVG was associated with lower 10-year mortality but carried a higher risk of aortic reoperation. While the
risk of reoperation is largely tied to valve choice, follow-up mortality is more likely to be influenced by patient
comorbidities and risk factors.

Keywords: Aortic root surgery, mechanical prosthesis, biological valve, composite valve graft, Bentall-De Bono,
survival, reoperation

INTRODUCTION
The Bentall-De Bono operation is the preferred treatment for patients with ascending aortic/aortic root
[1]
dilation and aortic valve pathology in need of surgical repair . While the use of a Dacron graft is universal
for the procedure, the decision to use either a biological or mechanical valve is individualized based on
[2,3]
patients’ characteristics and preferences . Valve-sparing root replacement has evolved as a reliable aortic
root replacement technique, offering the unique advantage of preserving the native valve . While this may
[4]
be an option for patients with good quality aortic valves, the Bentall-De Bono procedure remains the
mainstay of treatment, especially in those with concomitant aortic stenosis.

Both types of aortic valve grafts have different profiles that favor their use in certain subgroups of patients.
On one hand, mechanical composite valve grafts (mCVGs) are associated with low rates of structural valve
deterioration but require lifelong anticoagulation. Currently, the only approved anticoagulant is warfarin,
which requires dietary compliance and strict monitoring of therapeutic drug levels. Conversely, biological
composite valve grafts (bCVG) do not require anticoagulant therapy but are associated with higher rates of
structural valve degeneration, leading to a higher reoperation rate. Consequently, age is one of the most
relevant determinants of the type of valve used, with patients younger than 60 years old usually receiving a
mCVG and older patients a bCVG .
[5,6]

The aim of this paper is to assess the follow-up mortality and reoperation rate in patients who underwent a
Bentall-De Bono operation at our institution based on the type of composite valve graft used.

METHODS
Study design
This is a retrospective cohort study based on prospectively collected data from our institutional aortic
surgery database (Weill Cornell Medicine, New York, USA).

Ethics
This analysis was approved by the Weill Cornell Institutional Review Board (#1607017424, January 9, 2022)
in New York. The need for individual consent was waived.