Operative predictors of mortality and neurologic outcomes after modified Bentall for acute aortic dissection: A systematic review and meta-analysis

Abstract

Introduction

The modified Bentall procedure is frequently required in acute type A aortic dissection (ATAAD) with root involvement, a high-risk subgroup with substantial early mortality and neurologic complications. Prior studies have examined operative predictors such as cardiopulmonary bypass (CPB) time, cross-clamp duration, circulatory arrest, and conduit type, but findings remain inconsistent. This systematic review and meta-analysis aimed to determine whether specific operative parameters influence early mortality or neurologic outcomes following the Bentall procedure in ATAAD.

Methods

A systematic search of PubMed, Embase, CENTRAL, ProQuest, and Google Scholar was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fifteen observational studies evaluating adult ATAAD patients undergoing the modified Bentall procedure were included. Pooled proportions of early mortality and neurologic complications were calculated using a random-effects model. Heterogeneity, publication bias, sensitivity testing, and meta-regression were conducted to assess associations between operative variables—including CPB time, cross-clamp time, circulatory arrest duration, operative time, conduit type, and concomitant coronary artery bypass grafting (CABG)—and postoperative outcomes.

Results

Across 1547 patients, pooled early mortality was 13%, and the pooled rate of postoperative neurologic complications was likewise 12%. Sensitivity analyses showed stable results. Meta-regression demonstrated no significant association between any operative parameter and early mortality or neurologic events (all p > 0.05). No substantial publication bias was detected.

Conclusion

Among ATAAD patients undergoing the modified Bentall procedure, early mortality and neurologic complication rates remain acceptable. The absence of significant operative predictors suggests that advances in perfusion, myocardial protection, and cerebral management may mitigate time-related risks. Further multicenter studies are needed to refine risk stratification.