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Bentall operation

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					              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
                 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
                   Pioneer
• Homograft
  replacement of the
  ascending aorta.
  Drawings showing
  final anastomosis of
  homograft to base of
  ascending aorta
  (DeBakey)
                Indication
• AR, dilated aortic root( 5cm)
• Marfan’s syndrome
• Dissection aortic aneurysm
                 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.
Procedure
                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
Procedure
               Discussion
• Deep hypothermia cardiac arrest ( 15-18
  without clamp, 45 mins)
• retrograde cardioplegia
• pseudo-aneurysm caused by wrapping
• residual AR
• Resuspension of aortic valve

				
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