Objectives <p>This study sought to examine the factors associated with postoperative complications following the Bentall procedure by conducting a retrospective single-center cohort analysis. In addition, the study aimed to develop a nomogram model for postoperative risk prediction.</p> Methods <p>A total of 193 patients who underwent Bentall surgery in our hospital from May 2022 to May 2024 were included consecutively, of which 16 developed complications within 30 days after surgery. Preoperative demographic characteristics, preoperative cardiac function, intraoperative parameters, and other data were collected. Single-factor analysis was used to screen potential-related factors (<i>P</i> &lt; 0.10), and modeling variables were determined based on clinical evidence and the principle of "at least 10 positive events per variable". Firth penalty logistic regression was used to analyze independent risk factors and construct a nomogram. Internal validation was performed using the Bootstrap method with 1000 resamples, and the calibrated AUC, calibration slope, intercept, and Brier score were calculated. Loess calibration curve and decision curve were also plotted. A risk scoring system based on regression coefficient weights and clinical guidelines was established, and patients were divided into low, medium, and high-risk groups. The incidence of complications between above groups was analyzed.</p> Results <p>Multivariate Firth regression showed that preoperative NYHA functional classification (OR = 2.185, 95% CI 1.201–3.964), intraoperative aortic occlusion time (OR = 1.014, 95% CI 1.002–1.026), and pure intraoperative bleeding volume (OR = 1.002, 95% CI 1.000–1.004) were independent risk factors for postoperative complications in Bentall (all <i>P</i> &lt; 0.05). The nomogram constructed based on the above variables, after Bootstrap correction, had an AUC of 0.817 (95% CI 0.765–0.889), a calibration slope of 0.95 (95% CI 0.81–1.09), an intercept of 0.05 (95% CI −&#xa0;0.15–0.25), and a Brier score of 0.078, indicating good discrimination and calibration. The decision curve showed a clinical net benefit within the threshold range of 5–65%. The risk scoring system (0–18 points) divided patients into low-risk group (0–5 points, 102 cases), medium-risk group (6–12 points, 65 cases), and high-risk group (≥ 13 points, 26 cases). The incidence of complications in the three groups was 2.94%, 13.85%, and 53.85%, respectively, and the overall difference between the groups was statistically significant (<i>P</i> &lt; 0.001). Pairwise comparison showed that the incidence of complications in the high-risk group was significantly higher than that in the medium and low-risk groups (both <i>P</i> &lt; 0.05), and the medium-risk group was significantly higher than the low-risk group (<i>P</i> &lt; 0.05).</p> Conclusions <p>Preoperative NYHA cardiac function classification, intraoperative aortic occlusion time, and pure intraoperative bleeding volume are independent risk factors for postoperative complications in Bentall. The nomogram and risk stratification model constructed based on this exhibit good discriminative ability and calibration in this cohort, which can identify high-risk patients early before/during surgery and provide reference for personalized interventions. The performance of the model still requires external validation from multiple centers.</p>