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Bentall operation

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Dissection aortic aneurysm. Procedure. Establish cardiopulmonary bypass. cross ... pseudo-aneurysm caused by wrapping. residual AR. Resuspension of aortic valve ... – PowerPoint PPT presentation

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Title: Bentall operation


1
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

2
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

3
Pioneer
  • Homograft replacement of the ascending aorta.
    Drawings showing final anastomosis of homograft
    to base of ascending aorta (DeBakey)

4
Indication
  • AR, dilated aortic root( 5cm)
  • Marfans syndrome
  • Dissection aortic aneurysm

5
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.

6
Procedure
7
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

8
Procedure
9
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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