Medium-long-term results of using aortic homographs and Bentall procedures in aortic root pathologies: the experience of one center

Introduction. Aortic root replacement in young patients requires balancing the durability of mechanical valves with the reduced risk of thromboembolism and bleeding associated with biological implants. Cryopreserved homografts represent a promising alternative to the Bentall procedure. Objective. To perform a comparative analysis of clinical and valve-related outcomes in patients undergoing elective aortic root replacement using either homografts or mechanical prostheses. Materials and methods. This retrospective study included 85 patients operated on from 2015 to 2021: 19 patients received cryopreserved homografts (mean age 50,05 ± 16,35 years), and 66 patients underwent the Bentall procedure (mean age 52 ± 14,03 years). The cumulative follow-up was 423 patient-years. Survival rates, hospital and mid-term mortality, and complication rates were analyzed. Results. Hospital mortality was 2 cases in the Bentall group; no hospital deaths occurred in the homograft group. Mid-term mortality in the Bentall group was 4 cases (one related to valve thrombosis and stroke), while one death in the homograft group was unrelated to the prosthesis. In the Bentall group, bleeding events (n = 5, 7,58 %) and thrombosis (n = 3, 4,5 %) were observed; no such complications occurred in the homograft group. Leaflet stenosis was detected in one homograft patient without clinical significance and without need for reoperation. Conclusion. Both approaches provide satisfactory outcomes in elective settings. However, homografts showed a more favorable safety profile, including absence of thrombosis, bleeding, and reoperations. This makes them a promising option for young patients, although long-term durability data are needed