The David Versus the Bentall Procedure for Acute Type A Aortic Dissection

<b>Background</b>: Type A aortic dissection (TAAD) is a life-threatening condition which requires prompt diagnosis and surgical treatment. When TAAD involves the aortic root, aortic valve-sparing or Bentall procedures are the main surgical treatment options. <b>Method:</b> The subjects of this analysis were 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD). Propensity score matching was performed by estimating a propensity score from being treated with the Bentall or the David procedure using multilevel mixed-effects logistics, considering the cluster effect of the participating hospitals. <b>Results:</b> A Bentall procedure was performed in 862 patients, while a David operation was performed in 139 patients. The proportion of aortic root replacement, as well as the different techniques of aortic root replacement, varied significantly between the participating hospitals (<i>p</i> < 0.001). After propensity score matching, we obtained two groups of 115 patients each, and no statistical differences were reported in terms of postoperative outcomes, except for the rate of dialysis, which was higher in the patients requiring a Bentall procedure (17.4% vs. 7.0%, <i>p</i>-value 0.016). In the unmatched cohorts, the David procedure was associated with a lower 10-year mortality rate compared to the Bentall procedure (30.1% vs. 45.6%, <i>p</i>-value 0.004), but no difference was observed after matching (30.0% vs. 43.9%, <i>p</i>-value 0.082). After 10 years, no differences were observed in terms of proximal aortic reoperation (3.9% vs. 4.1%, <i>p</i>-value 0.954), even after propensity score matching (2.8% vs. 1.8%, <i>p</i>-value 0.994). <b>Conclusions:</b> The David and Bentall procedures are durable treatment methods for TAAD. When feasible, it is advisable that the David procedure is performed for acute TAAD by surgeons with experience with this demanding surgical technique.

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Publication Details

Journal
Journal of Cardiovascular Development and Disease
Published
2024-11-19
DOI
https://doi.org/10.3390/jcdd11110370
Citations
3
Primary Topic
Aortic Disease and Treatment Approaches
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article
Field-Weighted Citation Impact
1.26
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article

The David Versus the Bentall Procedure for Acute Type A Aortic Dissection

Jan Roček, Manoj Kuduvalli, Mark Field, Konrad Wisniewski et al.
3 citations
Journal of Cardiovascular Development and Disease
Aortic Disease and Treatment Approaches
1.26
article

The David Versus the Bentall Procedure for Acute Type A Aortic Dissection

Jan Roček, Manoj Kuduvalli, Mark Field, Konrad Wisniewski, Daniela Piani, Daniele Fileccia, Timo Mäkikallio, Javier Rodríguez Lega, Joscha Buech, Zein El‐Dean, Antonio Fiore, Luisa Ferrante, Eduard Quintana, Francesco Onorati, Mauro Rinaldi, Dario Di Perna, Caroline Radner, Fausto Biancari, Matteo Pettinari, Arianna Galotta, Igor Vendramin, Andrea Perrotti, Amer Harky, Lenard Conradi, Till Demal, Giuseppe Gatti, Sven Peterß, Giorgio Mastroiacovo, Robert Pruna‐Guillen, Giovanni Mariscalco, Petr Kačer, Angelo M. Dell’Aquila, Tatu Juvonen, Giuseppe Nanci, Ángel González Pinto
article en
3 citations

Abstract

<b>Background</b>: Type A aortic dissection (TAAD) is a life-threatening condition which requires prompt diagnosis and surgical treatment. When TAAD involves the aortic root, aortic valve-sparing or Bentall procedures are the main surgical treatment options. <b>Method:</b> The subjects of this analysis were 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD). Propensity score matching was performed by estimating a propensity score from being treated with the Bentall or the David procedure using multilevel mixed-effects logistics, considering the cluster effect of the participating hospitals. <b>Results:</b> A Bentall procedure was performed in 862 patients, while a David operation was performed in 139 patients. The proportion of aortic root replacement, as well as the different techniques of aortic root replacement, varied significantly between the participating hospitals (<i>p</i> < 0.001). After propensity score matching, we obtained two groups of 115 patients each, and no statistical differences were reported in terms of postoperative outcomes, except for the rate of dialysis, which was higher in the patients requiring a Bentall procedure (17.4% vs. 7.0%, <i>p</i>-value 0.016). In the unmatched cohorts, the David procedure was associated with a lower 10-year mortality rate compared to the Bentall procedure (30.1% vs. 45.6%, <i>p</i>-value 0.004), but no difference was observed after matching (30.0% vs. 43.9%, <i>p</i>-value 0.082). After 10 years, no differences were observed in terms of proximal aortic reoperation (3.9% vs. 4.1%, <i>p</i>-value 0.954), even after propensity score matching (2.8% vs. 1.8%, <i>p</i>-value 0.994). <b>Conclusions:</b> The David and Bentall procedures are durable treatment methods for TAAD. When feasible, it is advisable that the David procedure is performed for acute TAAD by surgeons with experience with this demanding surgical technique.

Journal of Cardiovascular Development and DiseaseVol. 11(11)
University of Verona (IT), Cliniques Universitaires Saint-Luc (BE), University of Helsinki (FI), University of Liverpool (GB), Inserm (FR), Université Paris-Est Créteil (FR), Charles University (CZ), Helsinki University Hospital (FI), Glenfield Hospital (GB), Hospital General Universitario Gregorio Marañón (ES), Liverpool Heart and Chest Hospital (GB), Centro Cardiologico Monzino (IT), Fondazione Ricerca Molinette (IT), Assistance Publique – Hôpitaux de Paris (FR), University Hospital Münster (DE), South Karelia Central Hospital (FI), Hospital Clínic de Barcelona (ES), German Centre for Cardiovascular Research (DE), Hôpitaux Universitaires Henri-Mondor (FR), Centre Hospitalier Annecy Genevois (FR), University Hospital Cologne (DE), University Hospital Kralovske Vinohrady (CZ), Institut Mondor de Recherche Biomédicale (FR), Azienda Sanitaria Universitaria Integrata di Trieste (IT), University of Turin (IT), Martin Luther University Halle-Wittenberg (DE), Universitat de Barcelona (ES), Ludwig-Maximilians-Universität München (DE), Université de Franche-Comté (FR), University of Oulu (FI)
Good health and well-being
Openalex Percentile: Top 18%
Aortic Disease and Treatment Approaches
1.26
DOIOpen Access PDFOpenAlex
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