Aortic root surgery ,Bentall opeartion and its modifications

1. (Bentall Operation)
Rami Ibrahim Abdelrehim
Assisstant lecturer of cardiothoracic surgery
Al-Azher university
by

2. Aortic root anatomy
The aortic root connect the LV to the
systemic circulation and its function is to
provide intermittent unidirectional
channeling of blood with laminar flow and
minimal resistance .

3. Aortic root components
- Aortic valve leaflets
- Annulus
- The sinuses of valsalva
- The interleaflet triangles
- The sinotubular junction (STJ)

7. - The normal range has to be corrected for age and sex
- Aortic size index (Zscore) = aortic diameter by BSA

8. When to replace the aortic root ?
- Annulo-Aortic Ectasia
- Aneurysm of sinus of valsalva
- Aortic Root abscess
-Stanford type A thoracic
aortic dissection
- Small aortic root: if root sparing techniques are not possible

10. Aortic root assessment ??
Cradiac MRI
Echocardiography (TTE,TEE)
Multislice CT
with contrast-

11. Aortic Root Replacement
(Bentall operation)
- Described by Hugh Bentall and
Antony De Bono , london 1968
- include Replacement of the
aortic valve, root and
ascending aorta

12. The Classical Bentall procedure
-opened the aortic aneurysm longitudinally,
-sutured a mechanical caged-ball valve Starr–
Edwards inside of the end of tube graft
-sutured the mechanical valve incorporated
inside the tube graft inside the aortic orifice with
use of isolated sutures.
-
- Coronary ostia anastomosed to holes in TG with
inclusion technique.
- distal anastomosis of graft to the ascending aorta
- Wrapping the graft with the aneurysmatic sac

13. - The early results were tenuous anastomosis from
implantation of coronaries into TG by inclusion Technique and
furthure pseudoaneurysm formation at the coronary
anastomosis
- The contained blood between the graft and wrapping could
tear-off the anastomosed coronary ostia
cabrol
??

14. 1981, Christian Cabrol)
)
Cabrol shunt
shunt by direct suturing of
the right atrial appendage to
the aneurysmatic sac or
the connection was created
with use of a vascular graft
or greater saphenous vein
,however this shunt is
temporary and thrombsed
within few hours after
protamine administartion and
normalization of coagulation

15. Cabrol operation

16. Cabrol opeartion
alternative technique of connecting the coronary ostia to the
Dacron
neoaorta by means of another Dacron graft 8 mm
to both RT , LT ostia and the to the TG with oval 1.5 cm long
side-to-side anastomosis.
however, it also carried a risk of graft thrombosis or
anastomotic stenoses.
,
the Cabrol technique used only in situations where the
coronary ostia are so remote that they cannot be safely
moved to the conduit. This is usually the case in
reoperations where the coronary ostia are firmly
encased in adhesions

17. Nicholas Kouchoukos ,the button technique , 1980
Mobilization of coronary ostia free of tension
( modefied Bentall )

18. Modefication for better haemostasis
Copeland technique ,1993. French cuff” technique by
Tristan Yan ,2016
To apply the “French Cuff” technique, the tube graft selected
should be 5 mm greater in diameter than the valve size

19. Endo-button buttress
technique by Pratali ???
modified Bentall :
Kawazoe in 1993 and Kito
in 1994
Carrel patch OR teflon felt
to prevent the cutting through in
case of poor quality of the
coronary ostia aortic wall
Hashimoto prefers patch
from autologous
pericardium

20. - Bentall procedure is
performed through standered
median sternotomy approach
,However it may be
approached through limited
upper ministernotomy
(mini-Bentall)
- Mechanical or bioprothetic valve (Bio-Bentall)
- Young ,Redo,Anticoagulant

21. Bentall procedure is currently a routine operation.
In-hospital mortality of this procedure has markedly
decreased

22. DO NOT forget SCREENING of family member in pt
with heriditary thoracic aortic aneurysm

23. Thank YOU