Bentall – Aortic Root Surgery with Small Incision
Ascending aortic aneurysm occurs mostly with aortic root enlargement. This appears generally, with aortic valve insufficiency or the aortic valve insufficiency may enlarge the aortic root. Whatever the reason is, replacement of aortic root enlargement with the valve is what we call Bentall Surgery.
This procedure is identified and performed by Bentall in 1968 and it is known as one of the most complex surgeries in Cardiac Surgeries. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC47179...)
Because in Bentall, the aortic aneurysm is not the only case. As you may view the image below, the aortic aneurysm is expanded to aortic root. Aortic valve and coronary arteries are located in the aortic root so these are also affected by the enlargement. Aortic root has a thin-wall structure and enlarges towards large curvature of the aorta.
The most dangerous complication of an aortic aneurysm is the vessel rupture or dissection. That is why ascending aortas that reach to such an extent need surgical intervention. Today, there are no interventional treatments for aneurysms in this position. According to Cardiovascular Surgery Guides, if the expanding aorta size is >=55 mm, surgical intervention is needed promptly. However for some cases, where the size surpasses >=50 mm and where there is labile hypertension and/or Marfan Syndrome, connective tissue looseness and this kind of cases need preventative surgery indication as these illnesses have potential risks of increasing factors. (http://vascular-endovascular-surgery.imedpub.com/c...).
aortic aneurysm can be found easily with echocardiography. However,
high definition computed tomography is considered as the most
important method of diagnosis. MRI and Angiography can also be used
for size measurement.
In Bentall Surgeries which is one of the most complex surgeries in Cardiovascular Surgery, Ascending Aorta is completely resected (removed). Resection is put out towards Aortic Root and Coronary Arteries are separated from starting points and prepared to re-stitch.
The aortic valve is completely resected. This means, in this kind of cases, aortic valves are not appropriate for a repair because of stenosis or insufficiency so the valve needs to be changed. This is a situation we frequently encounter in Bicuspid.
As it is seen in the picture, the aortic valve is changed with a biological or metal (mechanic) valve and including aortic root, all expanding aorta is changed with “Graft” “which is made from an artificial material. There are some companies that produce grafts and they are appropriate to be used for Bentall Surgeries. After these, as seen in the picture, Coronary Arteries are re-implanted which mean coronary arteries are grafted with new aortas.
All these operations require precision and geometry mastery. Because if the coronary arteries are stitched irregular, wrong or insufficiently, cardiac functions may be damaged and we may encounter complications. This is what makes Bentall Surgeries complex.
The results are generally satisfactory in good hands. Surgical mortality changes 1% to 12% in the literature. Bentall Surgeries may be performed with a small incision as shown in the picture of this article. The fact that Bentall Surgeries can be performed with small incision is very important because this shows us that even a serious surgery such as this, may be performed without affecting the patient cosmetically and cutting the bone which reduces bone complications. These facts also increases patient satisfaction after Bentall Surgeries.
Bentall Surgery is a preventative treatment method. It prevents patients from coronary failure and aortic rupture. With small incision method, there is a lower risk of infection and higher positive effects on patients’ psychologies.