What is Bentall Procedure?

The Bentall procedure is a kind of cardiac surgery to rectify, correct problems with aortic valves, aortic roots, and ascending aorta. The procedure is named after Hugh Bentall, who first performed and described it in 1968. Through the Bentall procedure damaged aorta is replaced and coronary arteries are re-implanted into the graft. The aorta is very important, it’s the main artery that carries blood from our heart to the rest of our body. Aorta is the largest artery in the human body.

Purpose, need of the Bentall Procedure

The problems with the aortic valve and aorta can happen due to various medical reasons.

One of the most common medical conditions for aorta disorder is Marfan syndrome. It is a genetic condition, which causes problems with a person’s connective tissue, even affects and damages some of the tissue in the aortic root and valve. This damage can cause the area not to form normally and it develops problems over time. In addition to other possible medical problems, a person suffering from Marfan syndrome may have an aneurysm form in their ascending aorta.

However, apart from Marfan syndrome, people develop problems in these areas for underlying reasons.

• Other hereditary conditions, which affect the heart.
• Serious Infections.
• Congenital heart diseases.
• General degeneration caused by high blood pressure.

These problems need to be surgically repaired if the aneurysm is large enough or it has already ruptured.

Why a person need a Bentall Procedure?

After proper medical examination, doctor may recommend a Bentall procedure for repairing the problems with your aorta. Some of the most common problems that requires Bentall procedure includes:

• Aortic regurgitation – It is a condition when heart’s aortic valve doesn’t close properly.
• Marfan’s syndrome – It is a disease from the time of birth, and it weakens the aortic wall thickness.
• Aortic aneurysm – It is the condition of widening of the aorta.
• Aortic dissection – It is the condition when the inner layer of the aorta tears or gets ruptured.

How a Bentall Procedure is performed?

After proper medical examination, if Bentall procedure is recommended for the treatment then it will be performed in the surgical or cardiac wing of the hospital.  Bentall procedure is performed under general anaesthesia and in the presence of the whole cardiac surgery team. With the heart temporarily stopped using cardiopulmonary bypass, (a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and the oxygen content of the patient’s body).

A surgeon will make a cut in your chest to reach the aorta and the aortic valve. The surgeon will clamp the aorta and will remove the diseased portion of aorta and aortic valve. The surgeon will replace that part of the aorta with a graft, which is a prosthetic tube. Surgically one end of the graft will be connected with the remaining, normal aorta. The other end of the graft, which contains the valve, is also sewn or fastened into the heart. The coronary arteries, which bring blood to the heart, are re-connected to make sure they receive adequate blood flow after the surgery.

After everything is put in order, the clamp is removed. You will come off the cardiopulmonary bypass, the heart-lung machine. Your heartbeat will resume, as the blood flows through the artificial valve and graft and out into the rest of your body. The surgeon will surgically close the incision across your chest and also your breastbone will be closed with wires. The entire Bentall procedure takes around five hours.

Post surgery for close and careful monitoring patients are usually required to stay in the intensive care unit for 2 – 3 days, and then in the general nursing unit for 4 – 5 days. During this hospital stay, doctors will regularly be examining your incision to make sure it is healing properly and you are stable and safe from all the complications.

Potential Risks of Bentall Procedure

Like all other forms of cardiac, open-heart surgery, the Bentall procedure has inherent risks. As it is a serious intervention, the possible complications include the following:

• Abnormal heart rhythm
• Low cardiac output
• Sepsis, or surgical wound infection
• Internal bleeding
• New aortic aneurysm or dissection of the aorta

Fortunately, the risks of many of such complications have decreased since the procedure was first performed, due to improved surgical techniques and an experienced surgical team.