What is a Bentall procedure?

From the Guidelines

A Bentall procedure is a complex cardiac surgery that involves replacing the aortic valve, aortic root, and ascending aorta with a composite graft, typically performed by experienced surgeons in Multidisciplinary Aortic Teams with a very low surgical risk 1. This procedure is often referred to as the modified Bentall procedure, which consists of a prosthetic aortic valve and aortic graft, with reimplantation of the coronary arteries. The Bentall procedure is typically performed when patients have conditions affecting multiple parts of the aortic root, such as aortic aneurysms with valve disease, Marfan syndrome, or aortic dissections.

• The surgery involves removing the damaged aortic valve and aortic root, implanting the composite graft, and then reimplanting the coronary arteries into the sides of the synthetic tube.
• The procedure requires cardiopulmonary bypass, where a heart-lung machine temporarily takes over the function of the heart and lungs.
• Recovery involves intensive care monitoring for 1-2 days, followed by a hospital stay of 5-7 days.
• Patients typically need 6-8 weeks for initial recovery and will require lifelong anticoagulation therapy if a mechanical valve is used or temporary anticoagulation with a tissue valve, as well as regular follow-up imaging to monitor the repair 1. The Bentall procedure has a very low surgical risk when performed by experienced surgeons, making it a viable option for patients with complex aortic root conditions 1.

From the Research

Definition of the Bentall Procedure

• The Bentall procedure is a surgical technique designed to address aortic root abnormalities, including issues with the aortic valve, aortic root, and ascending aortic disease 2.
• It involves graft replacement of the aortic valve, aortic root, and ascending aorta 3.

Purpose and Outcomes

• The procedure is used to treat various aortic root pathologies, such as dissection, Marfan syndrome, bicuspid aortic valve, degenerative disease, and atherosclerosis 2.
• The Bentall procedure can be performed with excellent short-term and long-term results, with overall survival rates of 0.95 at 5 years and 0.93 at 8 years 4.
• Event-free survival rates have been reported at 0.85 at 5 years and 0.78 at 8 years 4.

Surgical Techniques and Modifications

• The original Bentall technique involves reimplantation of the coronary arteries using a composite valved conduit 5.
• Several modifications have been proposed to improve patient outcomes and decrease intra- and post-operative complications, including the use of biological valved conduits and simplified techniques 6, 5.
• The choice of valve type, such as mechanical or biological, depends on various factors, including patient age and lifestyle 4.

Complications and Risks

• Graft infection after the Bentall procedure is a rare but severe complication, often difficult to diagnose and treat 3.
• Other potential complications include bleeding, stroke, endocarditis, and peripheral thromboembolic events 4.
• The risk of complications can be minimized with proper surgical technique, patient selection, and post-operative care 6, 2.