Early and late results of the Bentall operation for annulo-aortic ectasia.

Our experience is reported with 20 consecutive patients undergoing the Bentall operation during the past 10 years for ascending aortic aneurysms with aortic regurgitation due to idiopathic medical necrosis with a resultant annulo-aortic ectasia. Concomitant aortic dissection was present in 45% of the patients. In the earlier period from 1972 to 1976, the operative and hospital mortality rates were 40%, and it was reduced to 0% (p less than 0.08) in the later period from 1977 to 1981. Operative survivors showed the mean clinical improvement from the NYHA class 3.0 to 1.3. The LVEDP and the left ventricular dimension were significantly reduced toward normal (p less than 0.05 and p less than 0.001). The actuarial survival rate at 6 years after operation was 71% in this series. The Bentall operation can now be performed with a low risk, and can improve the clinical and hemodynamic states significantly. However, in patients with chronic type I aortic dissection, a false lumen remained patent after surgery regardless of the types of graft-distal aorta anastomosis. The fate of the remaining dissection is undetermined, but some may require further surgery.