الفهرس 
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Abstract
Aortic root surgery remains a challenge despite major improvements in diagnosis, surgical techniques and available materials in recent years. Different techniques have been adopted because of different pathologies that affect the aortic root and ascending aorta together with the aortic valve.
The introduction of composite valve grafts by Bentall and De Bono in 1968 has helped to expand the possibilities of definitive surgical treatment for the aortic root.
This study was conducted in the department of cardiothoracic surgery in Ain Shams University and National Heart Institute in order to assess the postoperative and short term (6 months post operative) outcomes in patients who underwent the Bentall operation (77 patients) due to either aortic root and ascending aneurysm (group A=53 patients) or acute type A aortic dissection (group B= 24 patients). The study was conducted from January 2010 to December 2013 with a mean period of 6 months follow up postoperatively.
The mean age of patients in group (A) was 45.92±13.57 years and in group (B) was 49.00±11.85 years. There was male predominance in both groups 56/21.
Pathologies involving the aortic root included: annulo-aortic ectasia (degenerative, rheumatic and congenital) causes in group (A) and acute aortic dissections in group (B) with other associated cardiac problems (mitral valve disease, coronary artery disease, tricuspid valve disease or aortic arch disease) that needed surgical correction were not exclusive criteria in the study.
We specified the early and short term outcomes of Bentall operation in aneurysm cases (group A) and dissection cases (group B) and this included the operative data, postoperative morbidity and mortality and follow up of the patients for 6 months with regular visits after one month, three month and six months intervals with clinical examination, chest X-ray, INR and echocardiography.
All patients had complete preoperative clinical evaluation with all required investigations (TTE, TEE or CT of the chest and abdomen, coronary angiography and carotid duplex in some cases) to evaluate the nature and extent of the aortic root pathology, cardiac performance and other associated diseases.
There was a statistically significant difference between the two groups in regard to usage of local hemostatic medications, mean values of operation time, CPB time, cross -clamp time and number of platelet unit transfusion all being higher in group B.
The mean time (hrs) needed for mechanical ventilation in group (A) was 13.62±21.48, while in group (B) was 19.38±22.88 with no statistical significant difference between both groups and the same was observed in the mean ICU stay 94.08±58.8 vs. 82.8±34.56 and total hospital stay (days) 13.17±6.35 vs. 10.29±6.37 with no significant values. All patients needed postoperative inotropic support with variable degrees within the (international ranges).
The early (30 days) mortality was 5 ̸ 53 (9.4%) patients in group (A) and 5 ̸ 24 (21%) patients in group (B) which is comparable with other international studies.
In our study, many factors were significantly a risk for 30 days mortality in the studied patients; female gender, COPD, DM, hyperlipidemia, renal dysfunction, NYHA class IV, the lower preoperative mean values of EF (≤ 47%), the higher mean values of aortic diameter and the higher mean values of operation time; CPB time, cross clamp time and ventilation time were significantly risk factors for 30 days mortality in the studied patients.
Echocardiographic evaluation of left ventricular dimensions in both groups revealed that there was significant reduction in LVEDD and LVESD between preoperative and early postoperative and between early postoperative and at follow up.
Improvement in the symptomatic status as assessed by the NYHA class was observed in both groups in the follow up period.