Clinical Analysis Of Bentall Operation For Patients With Aortic Root Diseases And Giant Left Ventricle

ObjectiveTo summarize the experience of Bentall operation for patients with aortic root diseases and giant left ventricle,and provide useful information for the optimal treatment strategies of these patients.MethodsClinical data from 64 cases of patients with aortic root diseases and giant left ventricle,who underwent Bentall operation at our centre between April 7th 2009 and September 30 th 2016 were analysed retrospectively.A total of 64 patients(57 males,7 females),who were aged from 14 to 70,average age(42.50±13.74),the course of disease being between 3 days to 20 years.21 cases were diagnosed as Marfan syndrome(32.81%),ascending aortic aneurysm in 15(23.44%),aortic root an eurysm in 10(15.63%),Marfan syndrome with aortic dissection in 8(12.50%),aortic dissection in 6(9.38%),ascending aorta dilatation in 4(6.25%).All patients with giant left ventricle(left ventricle end diastolic dimension LVEDD?70mm and left ventricle end systolic dimension LVESD?50mm)before the operation.Based on the New York Heart Association(NYHA)functional classification,there were29 cases of class ?(45.31%),28 cases of class ?(43.75%),7 cases of class ?(10.94%).58 patients were treated as electives(90.63%),6 patients were treated as emergencies(9.38%).Results1.The study included 64 patients,cardiopulmonary bypass time was 97 to 300 min,blocking time was 58 to 227 min,average time of hospitalization 26.27 d.Two patients died during Postoperative hospitalization(3.13%),1 cases died of low cardiac output syndrome,1 cases died of severe cardiac arrhythmia.There are 20 cases with early postoperative complications(31.25%,20/64),including reoperation in 7 cases(10.94%,7/64),low cardiac output syndrome in 7 cases(10.94%,7/64),pleural effussion or aerothorax in 4 cases(6.25%,4/64),Poor healing of Operative incision in 3 cases(4.69%,3/64),infection in 2 cases(3.13%,2/64),acute renal failure in 1 cases(1.56%,1/64),Left atelectasis in 1 cases(1.56%,1/64).2.To February 2018,eight(12.90%,8/62)patients lost contact(Because the patient changed his phone number).The follow-up was completed in 54 cases(87.10%)(54/62),with a mean time of 53.95±24.45(16-102)months,during which 53(94.64%)of the patients survived,including 40 cases of NYHA class ? and 13 cases of class ?,and 1(1.85%)died of upper respiratory tract infection after 16 months since operation.There were 6 cases with postoperative complications(11.11%,6/54),including reoperation in 2 cases,bleeding due to Warfarin overdosage in2 cases,atrial fibrillation in 1 case,cerebral infarction in 1 case.3.Cardiacultrasound data from 30 cases before and at 1 week,3 months and 1 year after operation was retrospectively analyzed.Compared with the baseline,LVEDD and LVESD decreased significantly at 1 week,3 months and 1 year after operation in a time-dependent manner(P <0.001),while LVEF decreased at 1week(P <0.01),and increased significantly at 3 months(P<0.05)and 1 year after operation in a time-dependent manner(P <0.001).4.Direct cardioplegic administration via the coronary ostia was performed in62 cases(96.88%),combined antegrade and retrograde cardioplegia in 2 cases(3.13%).After operation,automatic heart re-beating succeeded in 36 cases(56.25%).26 cases(40.63%)needed electric shock promoting heart re-beating.Ventricular fibrillation was found in 2 cases(3.13%).5.In the present series,7 patients(10.94%,7/64)needed reoperation because of excessive postoperative bleeding after open-heart surgery.Aortoatrial shunts were performed in 47 cases(73.44%,47/64),including 16 cases of aortoatrial shunts with inaccessible bleeding in aortic root,Preventive aortoatrial shunts were performed in 31 cases.6.Low cardiac output syndrome was found in 7 cases(10.94%,7/64),rehabilitation discharge succeeded in 6 patients with IABP application.One case died of low cardiac output syndrome without IABP application.During follow-up,these pati ents had good cardiac function,including 4 cases of NYHA class ?,1 case of class ?.One case was lost.Conclusions1.The Bentall procedure is durable and safe for patients with aortic root diseases and giant left ventricle,with a satisfactory result.2.The left ventricular volume of the patients decreased significantly after operation in a time-dependent manner,the systolic function of heart reduced in the early postoperative period,which,however,may gradually improve with time and become better than the preoperative status.3.The main postoperative complications of patients with aortic root diseases and giant left ventricle are postoperative hemorrhage and low cardiac output syndrome but early reoperation and IABP application can improve clinical outcomes.4.A low automatic heart re-beating rate was found in the patients with aortic root diseases and giant left ventricle who underwent Bentall operation.