MID-TERM OUTCOMES OF MODIFIED BENTALL USING A SELF- ASSEMBLED BIOLOGICAL COMPOSITE GRAFT WITH INSPIRIS RESILIA VALVE

Background: The modified Bentall procedure is a standard surgical approach for aortic root pathologies, including aneurysms, endocarditis with abscess, and aortic dissections. Despite requiring aortic valve replacement, this procedure yields excellent results. Prosthesis selection should be individualized based on patient characteristics, contraindications to anticoagulation, and patient preference. This study aims to assess early and mid-term outcomes of the modified Bentall procedure using a 4th generation pericardial valve. Methods: This multicentric observational prospective registry includes patients from three French centers, enrolled from 2019 to 2023. Inclusion criteria involved all consecutive patients undergoing modified Bentall with the Inspiris Resilia aortic valve bioprosthesis. Patients under 18 were excluded. Of the 1208 patients, 151 met the inclusion criteria (mean age: 61.9 ± 9.8 years, 11.3% female, mean EuroSCORE II: 5.3%). Results: In-hospital mortality was 2.6%. At 30 days, mortality was 6.0% for aortic aneurysm, 16.4% for aortic dissection, and 20% for endocarditis. Severe patient-prosthesis mismatch was observed in 1.7% at discharge. Four-year follow-up (median 25 months) showed 2.6% endocarditis, 0% severe structural deterioration, 12.6% overall mortality, and 9.3% cardiac- related death. Conclusions: The modified Bentall with a biological composite graft is safe and effective for various aortic root pathologies. Incorporating the 4th generation Inspiris Resilia valve into the Valsalva graft does not complicate the procedure. Aortic root aneurysm patients show excellent early and mid-term outcomes, with a 90.2±5.5% survival rate at 4-year. Longer follow-up is needed to evaluate long-term outcomes.