What is Bentall procedure?

What is Bentall procedure?

Bentall procedure is done for ascending aortic disease in association with aortic valve disease requiring surgical treatment. A composite graft is used to replace the proximal ascending aorta and the aortic valve. It is a procedure requiring median sternotomy and cardiopulmonary bypass. Sometimes Bentall’s procedure is also done for proximal aortic dissection involving the aortic valve.

As the aortic root is replaced, coronary arteries have to be re-implanted into the composite graft. In a modification of the procedure, a full thickness button of aorta surrounding the coronary ostium has been used for making it easier to implant the proximal end of the coronary arteries into openings made in the aortic vascular graft. Button technique is especially useful in the presence of a fragile aortic wall. It has also been shown to improve late survival [2].

There is a trend towards valve sparing aortic root replacement in case of proximal aortic aneurysm and dissection. In a study of 25 patients undergoing valve sparing aortic root replacement, 8 had moderate aortic regurgitation while 6 had severe aortic regurgitation. The study documented acceptable morbidity and mortality with a comparable long term survival in comparison with Bentall procedure. Concomitant coronary artery bypass grafting excluding coronary reimplantation was also performed in 8 patients in the valve sparing group [3].

References

1. Cherry C, DeBord S, Hickey C. The modified Bentall procedure for aortic root replacement. AORN J. 2006 Jul;84(1):52-5, 58-70; quiz 71-4. doi: 10.1016/s0001-2092(06)60098-7. PMID: 16881491.
2. Bachet J, Termignon JL, Goudot B, Dreyfus G, Piquois A, Brodaty D, Dubois C, Delentdecker P, Guilmet D. Aortic root replacement with a composite graft. Factors influencing immediate and long-term results. Eur J Cardiothorac Surg. 1996;10(3):207-13. doi: 10.1016/s1010-7940(96)80298-3. PMID: 8664022.
3. Skripochnik E, Michler RE, Hentschel V, Neragi-Miandoab S. Repair of aortic root in patients with aneurysm or dissection: comparing the outcomes of valve-sparing root replacement with those from the Bentall procedure. Rev Bras Cir Cardiovasc. 2013 Oct-Dec;28(4):435-41. doi: 10.5935/1678-9741.20130072. PMID: 24598946; PMCID: PMC4389436.