Aortic root replacement (Bentall)
The aortic valve, root and ascending aorta are replaced in one go with a tube graft that has a valve built in.
Why it's done
- Aortic root aneurysm, typically around 5.5 cm, or smaller in Marfan syndrome and other connective tissue disease.
- A diseased aortic valve together with a dilated root.
- Root destruction from endocarditis (abscess) or dissection involving the root.
The steps
- Arrest and transect: Bypass and arrest, then the ascending aorta is divided.
- Coronary buttons: The aortic sinuses are cut away, leaving a cuff of aortic wall around each coronary opening, called a coronary button.
- Sew in the conduit: A composite graft (a valve already mounted inside a Dacron tube) is sewn to the annulus.
- Reimplant the coronaries: Holes are made in the graft and the coronary buttons are sewn onto them.
- Distal anastomosis: The top of the graft is joined to the remaining aorta.
Risks
- Bleeding from several suture lines
- Kinking or tension on a coronary button causing ischaemia
- Stroke
- The usual valve risks: heart block, endocarditis, anticoagulation if mechanical
Recovery
Similar to valve surgery, with lifelong imaging of the rest of the aorta, especially in connective tissue disease.
St George's Cardiothoracic Surgery Society, City St George's, University of London.