Bentall operation

1
Bentall operation

• A technique for complete replacement of the
  ascending aorta
• Hugh Bentall and Antony De Bono
• Royal Postgraduate Medical Scholl, London, and
  Hammersmith Hospital

2
History

• 1956 Debakey et al 6 aortic dissection
• Myron Wheat , Jr medical therapy
• 1967 Houston group successfully excised an arch
  aneurysm and replace with a homograft
• 1968 Bentall and De Bono replacement of
  ascending aorta and aortic valve

3
Pioneer

• Homograft replacement of the ascending aorta.
  Drawings showing final anastomosis of homograft
  to base of ascending aorta (DeBakey)

4
Indication

• AR, dilated aortic root( 5cm)
• Marfans syndrome
• Dissection aortic aneurysm

5
Procedure

• Establish cardiopulmonary bypass
• cross-clamping the aorta distal to the aneurysm
• suture the tube prosthesis directly to the Starr
  valve
• Excise aortic cusps
• suture were placed in the aortic ring and through
  the Starr valve ring, fixed.

6
Procedure
7
Procedure

• Holes are cut in the aortic prosthesis at the
  site of the coronary ostia
• The aortic wall was sutured to the perimeter of
  the holes, reincorporating the coronary ostia
  with the new aorta
• complete the distal anastomosis

8
Procedure
9
Discussion

• Deep hypothermia cardiac arrest ( 15-18 without
  clamp, 45 mins)
• retrograde cardioplegia
• pseudo-aneurysm caused by wrapping
• residual AR
• Resuspension of aortic valve