Bentall Procedure

The aorta is the largest artery that stems from the heart and branches into smaller arteries to distribute oxygenated blood to all parts of the body. It can be divided into the ascending aorta (part that rises from the heart), aortic arch (part that bends over the heart), descending thoracic aorta (part that moves down the chest region) and abdominal aorta (part that begins at the diaphragm).

The Bentall procedure is a surgery performed to correct defects of the aorta. The procedure involves the replacement of the aortic root (base of the aorta) and valve (three flaps that ensure the one-way flow of blood from the heart to the aorta), and re-implantation of the coronary arteries (that branch out from the ascending aorta). The current and most common type of surgery is called the button Bentall surgery.

Indications

• The Bentall surgery is indicated for the following conditions of the aorta:
• Aortic regurgitation (leaking of the aortic valve)
• Marfan’s syndrome (genetic disease that causes aortic wall weakness)
• Aortic dissection (separation of the layers of the aortic wall)
• Aortic aneurysm (enlargement of the aorta)

Procedure

The Bentall surgery is performed under general anaesthesia. During the surgery, an incision is made along the middle of the chest to expose the heart. The heart’s activity is temporarily stopped so your surgeon can perform the operation, and blood flow is redirected to a bypass machine.

The diseased part of your aorta is excised and the valve is inspected. The diseased aortic valves are removed. The coronary arteries, along with a large button of the surrounding wall of the aorta are dissected. An artificial graft that has a mechanical or bioprosthetic valve is sutured to the ends of the aorta. Two holes are created in the graft, into which the coronary artery buttons are sewn. The valve replacement may be tested by your surgeon by streaming some blood into the area and checking for any kind of leakage. Once the repair is complete, the incision is sutured and bandaged. The entire procedure is normally completed in less than 5 hours.

Recovery

After the surgery, you will be taken to the post anaesthesia care unit and connected to a ventilator where your vitals will be monitored. Before discharge, your doctor will give you a set of instructions to be followed such as:

• Increase your activity progressively as tolerable
• Avoid any vigorous activity for up to 12 weeks after the surgery
• Do not lift any kind of heavy weights for the first few weeks after the surgery

Please inform your doctor if you experience the following:

• Chills
• High fever
• Drainage from the incision
• Incisional redness
• Increased incisional tenderness

Risks and Complications

As with all surgical procedures, the Bentall procedure may be associated with certain complications. Some of these complications include:

• Arrhythmias (irregular heartbeat)
• Pneumonia (lung infection)
• Septic shock (severe infection and inflammation)
• Bleeding
• Wound infections
• Disturbances in conduction and pace
• Neurological disorder
• Hepatic and renal insufficiency (failure of liver and kidney, respectively)

Your doctor will thoroughly consider your condition, and the benefits and possible risks of the Bentall procedure before proceeding with it.