Posterior Teflon-Felt-Reinforced Coronary Button Anastomosis in a Modified Bentall Procedure: Early Outcomes in a Single-Center Retrospective Study

Background: Coronary button reimplantation is a key determinant of operative safety in the modified Bentall procedure (MBP), and technical modifications aimed at improving anastomotic stability and hemostasis continue to evolve. This study investigated the early outcomes of a posterior Teflon-felt-reinforced coronary button technique in comparison with the conventional approach. Methods: Between January 2021 and May 2025, a total of 57 patients who underwent an elective modified Bentall procedure were included and divided into two groups: the conventional coronary button group (CCB, n = 30) and the posterior Teflon-felt-reinforced coronary button group (RCB, n = 27). Operative variables and early postoperative outcomes (including bleeding, re-exploration, and 30-day mortality) were compared between the two groups. Results: The CCB group included 9 women and 21 men with a mean age of 59.5 ± 9.6 years, whereas the RCB group consisted of 5 women and 22 men with a mean age of 57.3 ± 8.9 years. The mean maximum aortic root diameter was 49.6 ± 5.3 mm, and the mean ascending aortic diameter was 50.8 ± 4.9 mm. Aortic cross-clamp (ACC) and cardiopulmonary bypass (CPB) times were similar between the groups (p = 0.330 and p = 0.214, respectively). After excluding patients who underwent planned coronary artery bypass grafting (CABG; n = 8), the incidence of unplanned CABG was higher in the CCB group than in the RCB group [6 (24.0%) vs. 2 (8.3%); p = 0.136]. Postoperative 24-h chest tube drainage tended to be lower (p = 0.060), and re-exploration for bleeding occurred less frequently (11.1% vs. 30.0%, p = 0.076), with no coronary button-related bleeding after reinforcement. The RCB group required significantly fewer transfused blood products, including red blood cells, fresh frozen plasma, and platelets (all p < 0.01). Intensive care unit stay was shorter in the reinforced group (p < 0.01), with a trend toward reduced hospital stay (p = 0.085). Early mortality was comparable (p = 0.356). Conclusions: Posterior Teflon-felt-reinforced coronary button anastomosis may improve early hemostatic stability and provide additional mechanical support during coronary reimplantation in the modified Bentall procedure; confirmation in larger cohorts is required.