Bentall procedure

Bentall Procedure

The Bentall procedure is a surgical technique performed to correct abnormalities of the aorta, the main artery that carries blood away from the heart to the rest of the body. This procedure is particularly aimed at treating conditions such as an aortic aneurysm, aortic dissection, and Marfan syndrome that affect the aorta near the heart. The surgery involves the replacement of a section of the aorta and the aortic valve, and reimplantation of the coronary arteries into the graft.

Indications

The Bentall procedure is indicated for patients with significant structural abnormalities of the aorta and aortic valve, including:

• Aortic aneurysm: An enlargement of the aorta that can lead to rupture if left untreated.
• Aortic dissection: A tear in the inner layer of the aorta, which can cause internal bleeding and potentially lead to rupture.
• Marfan syndrome and other genetic conditions: These can weaken the wall of the aorta and lead to aneurysms or dissections.
• Aortic valve disease: When the aortic valve is also affected, either by stenosis (narrowing) or regurgitation (leakage).

Procedure

The Bentall procedure is performed under general anesthesia, with the patient on cardiopulmonary bypass, a machine that takes over the function of the heart and lungs during the surgery. The steps of the procedure include: 1. A median sternotomy is performed to provide access to the heart and aorta. 2. The patient is placed on cardiopulmonary bypass. 3. The diseased section of the aorta and the aortic valve are removed. 4. A composite graft, which includes a mechanical or biological valve at one end, is sewn into place where the aorta and valve were removed. 5. The coronary arteries are detached from the diseased aorta and reattached to the graft. 6. The patient is taken off cardiopulmonary bypass, and the sternum is closed.

Risks and Complications

As with any major surgery, the Bentall procedure carries risks, including:

• Bleeding
• Infection
• Stroke
• Heart attack
• Kidney failure
• Complications related to the use of the heart-lung machine
• Valve-related complications, such as thrombosis (clotting) if a mechanical valve is used, requiring lifelong anticoagulation therapy

Recovery

Recovery from the Bentall procedure involves a stay in the intensive care unit (ICU) for close monitoring, followed by a period of recovery in the hospital. The total hospital stay can range from a week to several weeks, depending on the patient's condition and any complications that may arise. Full recovery and return to normal activities can take several months.

Outcomes

The Bentall procedure has been shown to significantly improve the life expectancy and quality of life for patients with life-threatening aortic and aortic valve diseases. However, the long-term success of the surgery depends on several factors, including the type of graft and valve used, the patient's underlying health condition, and adherence to follow-up care and medication regimens.