What Is a Bentall Procedure?

A Bentall procedure is a type of surgical operation usually done in open heart surgeries that concerns the aorta, the largest artery of the heart. This can involve replacing some defective parts of the aorta, such as the valve or the upper part called the ascending aorta, with a graft. Some patients with Marfan syndrome may especially have to undergo a Bentall procedure, as the condition causes either a leaky heart valve or a bicuspid aortic valve, instead of the normal tricuspid valve. The procedure may also have to be performed in cases of aneurysms, in which the ascending aorta balloons out, in order to prevent the aorta from rupturing and causing a fatal hemorrhage.
The first surgeons who in 1968 described and experimented with the procedure were Drs. A. De Bono and Hugh Bentall, after whom the Bentall procedure is named. The technique was first achieved by sewing and wrapping the coronary arteries around the valve replacement using a method called “side to side anastomosis.” This means that a lengthwise incision is made on the artery in order for it to be grafted on the valve replacement. This method, however, resulted in further aneurysms after surgery, and was modified several times. The current and most common type of Bentall procedure used by surgeons is the “button” procedure, developed in 1991 by Dr. Kouchokos.
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After an incision in the chest area is performed, the heart is put under a cardioplegia, or the stopping of any heart activity, so no bleeding will occur and surgeons can perform the operation properly. The part of the aorta that needs to be replaced is then excised, and two coronary “buttons” opposite each other are dissected from the aortic wall. The valve replacement tube is then fitted and connected to the aorta using surgical needles and threads called sutures. Once the valve replacement is sewn in, the surgeon will then create two holes in the tube, in which the coronary buttons will be sewn. This method will help better secure the valve replacement in the aorta.
In between the steps, a surgeon will often test if the valve is properly secured on the aorta by streaming some blood into the area and making sure there is no leakage. Under normal circumstances, the Bentall procedure can be performed under five hours. Many studies have shown that 90% of patients who went through the procedure survived after ten years, after which the valve may need to be replaced with a new one. Patients, however, are often required to have regular visits to their cardiologists to constantly check if the valve is working properly.

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