What is the Bentall procedure (aortic root replacement)?

From the Guidelines

The Bentall procedure is a recommended surgical operation for treating aortic root aneurysms and associated aortic valve disease, involving replacement of the aortic valve, aortic root, and ascending aorta with a composite graft. This procedure is typically performed when a patient has conditions such as Marfan syndrome, aortic dissection, or other connective tissue disorders that cause weakening of the aortic wall 1. The Bentall procedure involves replacing the ascending aorta and aortic valve with a valved conduit (composite graft-valve device) with reimplantation of the coronary ostia into the sides of the conduit, with the prosthetic valve being either tissue or mechanical 1.

Key Considerations

• The procedure is usually indicated for patients with aortic root aneurysms, aortic dissection, or other conditions that weaken the aortic wall 1.
• During surgery, the coronary arteries are detached from the diseased aorta and reimplanted into the synthetic graft to maintain blood flow to the heart muscle.
• Recovery typically requires 6-8 weeks, with patients needing lifelong anticoagulation therapy (such as warfarin with a target INR of 2.0-3.0) if a mechanical valve is used 1.
• The procedure carries risks including bleeding, infection, stroke, and heart rhythm disturbances, but offers excellent long-term outcomes with survival rates comparable to the general population when performed electively 1.

Risks and Outcomes

• Surgical mortality for isolated elective replacement of the ascending aorta (including the aortic root) ranges from 1.6–4.8% and is dependent largely on age and other well-known cardiovascular risk factors at the time of operation 1.
• Mortality and stroke rates for elective surgery for ascending/arch aneurysms are in the range of 2.4–3.0% 1.
• For patients under 55 years of age, mortality and stroke rates are as low as 1.2% and 0.6–1.2%, respectively 1.

Follow-up and Monitoring

• Regular follow-up imaging with echocardiography or CT scans is essential to monitor the repair and detect any potential complications 1.
• Patients should be closely monitored for signs of complications, such as bleeding, infection, or stroke, and should receive lifelong anticoagulation therapy if a mechanical valve is used 1.

From the Research

Overview of the Bentall Procedure

• The Bentall procedure is a surgical technique used to replace the aortic root, which is the section of the aorta that connects to the heart 2, 3, 4, 5, 6.
• It involves replacing the aortic root with a composite graft, which includes a mechanical valve and a tube made of synthetic material 2, 3, 4, 5, 6.

Indications for the Bentall Procedure

• The Bentall procedure is typically used to treat patients with aortic root aneurysms or dissections, which can be life-threatening if left untreated 2, 3, 4, 5.
• It is also used to treat patients with aortic valve disease, such as aortic regurgitation or stenosis, who require replacement of the aortic root 2, 3, 4, 5, 6.

Outcomes of the Bentall Procedure

• Studies have shown that the Bentall procedure can be performed with acceptable morbidity and mortality rates 2, 3, 4, 5, 6.
• The perioperative mortality rate for the Bentall procedure has been reported to be around 6-13% 2, 3, 4, 5, 6.
• Long-term survival rates after the Bentall procedure have been reported to be around 79-92% at 7 years 2, 3.

Comparison with Other Surgical Techniques

• The Bentall procedure has been compared to other surgical techniques, such as valve-sparing root replacement, which has been shown to have similar outcomes in terms of morbidity and mortality 2, 3, 5.
• However, the Bentall procedure has been associated with a higher risk of thromboembolic and bleeding complications compared to valve-sparing root replacement 3, 6.

Recent Trends and Developments

• Recent studies have shown that the Bentall procedure is still a widely used and effective technique for replacing the aortic root, but it is no longer considered the gold standard for all patients 5, 6.
• Newer surgical techniques, such as valve-sparing root replacement, are being developed and studied as alternative options for patients with aortic root disease 2, 3, 5.