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)
Marfans 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