Work

Mechanical Versus Bioprosthetic Conduits for the Bentall Procedure: A 10-Year Propensity Score-matched Analysis of Early and Long-Term Outcomes

Year: 2026

Type: article

Abstract: OBJECTIVES: The optimal conduit choice for the Bentall procedure-mechanical (MC) or biological (BC)-is confounded by significant baseline selection bias. We aimed to evaluate the impact of conduit choice on early and long-term outcomes after mitigating this bias in a contemporary surgical cohort. METHODS: We retrospectively reviewed 442 consecutive patients undergoing elective Bentall procedures between 2015 and 2025 (365 MC vs 77 BC). Propensity score matching (1:1 nearest-neighbour, calliper 0.1) was performed based on 10 baseline covariates (including age, EuroSCORE II, and comorbidities) to generate a balanced cohort of 154 patients (77 per group). Operative outcomes, 30-day morbidity/mortality, long-term overall survival (OS), and reoperation-free survival (RFS) were compared using paired statistical tests and Kaplan-Meier (log-rank) analysis. RESULTS: Propensity score matching successfully balanced baseline covariates, eliminating significant differences in age (mean 64.1 [MC] vs 65.7 [BC] years, P = .403) and EuroSCORE II (P = .698). The median follow-up was 36.0 months (interquartile range [IQR]: 18.0-78.0). In the propensity-matched cohort, no significant differences were found in long-term OS (P = .574) or RFS (P = .944) between the mechanical and biological groups. Early mortality was also comparable (P = .344). However, the biological group demonstrated a significantly higher rate of early re-exploration for bleeding (24.7% vs 6.5%, P = .003), associated with a 3.8-fold increased risk (odds ratio [OR]: 4.72, 95% confidence interval (CI), 1.66-13.40). CONCLUSIONS: In this 10-year propensity-matched analysis, both mechanical and bioprosthetic conduits demonstrated comparable long-term durability and survival outcomes. Although biological conduits were associated with a higher risk of early re-exploration for bleeding, this did not adversely affect early mortality or long-term RFS. These findings suggest that bioprosthetic conduits offer robust mid-term effectiveness, provided that meticulous intraoperative haemostasis is ensured to mitigate early bleeding risks. CLINICAL REGISTRATION NUMBER: Not applicable (retrospective study).

Source: Interdisciplinary CardioVascular and Thoracic Surgery

DOI: 10.1093/icvts/ivag125

Authors: Emine Aleyna Eroglu Polat, Gokay Altaylı, Mehmet Okan Donbaloglu, Mucahit Polat

Institution: Mehmet Akif Ersoy Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi

Language: English

Topic: Aortic Disease and Treatment Approaches

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,258