A STUDY OF SURGICAL OUTCOMES OF MODIFIED BENTALL'S PROCEDURE IN A TERTIARY CARE CENTRE IN SOUTH INDIA (original) (raw)

The modified Bentall procedure remains a gold standard of aortic root surgery. . In 1968, Bentall and De Bono were the first to describe the surgical procedure for the reconstruction of the aortic root with a valved composite graft . For years, this technique became the practice standard for surgical treatment of dysfunctions of the aortic valve, root, and ascending aorta . In the original method, late intra-operative bleeding was controlled using circumferential suture lines on the coronary peri-ostium areas and an overall aortic wraparound . In the initial series, the postoperative complications like coronary detachment, formation of a false aneurysm, and need for re- operation in the Bentall operation were very high . Since then, with increased experience of the surgeon and technical improvements such as pre-clotting of grafts with albumin, enhancements in pump oxygenator systems, and accurate heparin adjustments the rate of complications has significantly dropped [6]. Several modified techniques have also been developed to further reduce the rate of complications and improve patient outcomes . Currently, the modified Bentall techniques that incorporate coronary button mobilization have become the procedure of choice in many centers around the world . Despite significant improvements with modified techniques, intra- operative blood loss and postoperative complications remain a major cause of morbidity and mortality. Therefore, the present study aims to evaluate this technique of modified Bentall's procedure for various conditions of ascending Aorta and evaluate the outcomes in southern Indian population. Total of 33 patients underwent Modified Bentall procedure from December 2018 to December 31st 2021. 25 patients fulfilled inclusion and exclusion criteria of our study. Out of the 25 patients,17(68%) were male and 8(32%) were female.In the present study most of them are in 40-50 years age group of 10 (40%) members followed by 6 In 20-30 years group, 4 in 30-40 years, 3 in 50-60 years, 1 in 60-70 years,1 patient in 70-80 years. The most common comorbidity was Hypertension, present in 15(60%) ,patients,, Type 2 diabetes was present in 2 (08%) patients. Both hypertension and diabetes was present in 2(08%) patients.6(24%) patients had no comorbidities.Most common symptom was shortness of breath and chest pain, seen in 8 (32%) patients and the next most common symptom was chest pain, seen in 6(24%) of patients followed by shortness of breath seen in 6 (24%.).Shortness of breath and chest pain with associated palpitation was seen in 2(8%).there was associated vomiting in one(4%) patientand loss of consciousness in one ( 4%)patient. Most cases presented within 4 days of onset of symptoms,5 patients presented late > 4 days after onset of symptoms.Most common aetiology was connective tissue disorder present in 14 cases, followed and unknown Aetiology in 6 patients and Atherosclerosis in 5 patients. Most common lesion was type A aortic dissection seen in 17( 68%) patients followed by ascending aortic aneurysm in 5 (20%) patients. Annulo aortic ectasia was seen in 3(12%) patients. Out of 25 cases, 15 (60%) cases were operated as emergency and the remaining 10(40%) cases were operated electively.In this study ,Aorta /Right Atrial Cannulation done in 12 (48%) patients, Axillary artery and Right Atrial cannulation was done in 11 (44%) patients, Aorto Bicaval cannulation was done in 2 (8%) patients. In 21 (84%) cases delayed sternal closure was done on the next day and in the remaining 4(16%) cases sternum was closed primarily.The longer duration between symptom onset and surgery was associated with high mortality. Similarly, atherosclerotic etiology of the aortic afflictions and emergency nature of surgery were associated with high mortality. Although patients with high inotropic support and multiple transfusions were expected to have high mortality, statistically significant association was not found. The use of deep hypothermic circulatory arrest along with selective antegrade cerebral circulation resulted in improved outcomes, although we did not include this aspect in our study. Further the use of improved local hemostatic agents also instrumental in improving early outcomes. The major limitation of the study were the limited numbers and also the retrospective nature of the study. Further the study did not include patients who underwent concomitant procedures.