Bentall surgery and the knowledge you need to know

Bentall is a difficult surgery, requiring the operator to be highly skilled so that the patient does not have to suffer much pain and does not lose a lot of blood. So what is Bentall surgery? In what cases is surgery necessary? SignsSymptomsList will help you with the answer.

Bentall surgery was born in 1968 by two doctors Bentall and De Bono. Since then until today, this surgical method has been widely applied in the treatment of diseases related to the aortic root, aortic valve and ascending aorta. Over time, surgical techniques have been improved to provide better treatment results.

What is Bentall Surgery?

Bentall is a surgery used to treat diseases related to the aortic root, such as aortic stenosis, aortic regurgitation , etc. This is a very complicated surgery and is not Frequent.

Bentall surgery includes valve replacement and aortic root, ascending thoracic aorta, coronary artery bypass grafting. In selected patients, surgery can be safely performed through a minimally invasive incision in the upper half of the sternum.

Bentall surgery has the effect of replacing the valve and the aortic root

A research report on the topic "Early results of Bentall surgery" by author Duong Duc Hung and his collaborators Cardiology Institute - Bach Mai Hospital took place. A total of 44 patients underwent Bentall surgery from January 2013 to March 2016 at the cardiovascular surgery unit of Bach Mai Hospital. The average age of the patients is 49.8 years, of which the youngest is 20 years old and the oldest is 73 years old. The percentages of patients are as follows:

• 72% male, 28% female.
• 45.05% have high blood pressure .
• 6.8% have diabetes.
• 9.1% had comorbid coronary artery disease.
• 6.8% of people had a history of Marfan's disease.

The study group all needed aortic dissection type A had severe aortic regurgitation and could not be preserved. In addition, they have aortic valve disease that requires replacement of an artificial valve with a dilated aortic root greater than 45mm. Some cases with Marfan syndrome (aortic root dilated over 55mm) have aortic valve disease, aortic dilatation.

How is Bentall surgery performed?

Dr. Hung analyzed that the Bentall method is implemented as follows:

• Sew the artificial vascular tube to the valve ring of a size 13 Starr ball valve.
• Replace the aortic root with this whole cluster.
• The coronary foramen is sutured to the wall of the artificial ductus arteriosus, the distal end of which joins the ascending aorta.

Bentall is surgery to treat pathology related to the aortic root

Depending on age, aspiration not to use anticoagulants, patients with contraindications to anticoagulation, the doctor will choose to use a catheter with a biological valve or a mechanical valve to replace the patient. In Vietnam, there are only artificial tubes with built-in mechanical valves of different sizes for use, there is still no pre-assembled mechanical valves.

The main technique of Bentall surgery is suturing the prosthetic valve to the aortic valve. Most of the stitches used are loose stitches, 2.0 woven thread with padding, stitching from the outside in. This will help keep the prosthetic ring within the aortic valve ring.

Dr. Hung shared, the most important technique in this surgical method is to make the mouth to connect the coronary hole to the valve tube. Throughout the study, there were 9 deaths, accounting for 9.1%. In which, 3 patients had emergency surgery due to aortic dissection. He emphasized that Bentall is a reasonable surgery, initially giving positive results in the treatment of diseases related to the valve and aortic root.

The first minimally invasive Bentall surgery in Vietnam

In the first quarter of 2022, Cho Ray Hospital in Ho Chi Minh City successfully performed the first minimally invasive Bentall surgery. The patient was indicated for surgery with aortic root aneurysm, aortic valve regurgitation.

Cho Ray Hospital is the first place in Vietnam to successfully perform minimally invasive Bentall surgery

Accordingly, a 49-year-old patient was admitted to the hospital with grade 2 - 3 heart failure due to long-term aortic regurgitation. After consulting, the Department of Resuscitation - Cardiac Surgery of Cho Ray Hospital decided to carry out surgery.

With the classic method, the doctor will replace the aortic root through the incision between the sternum. However, this method has some disadvantages such as large incisions, invasive surgery, and easy infection of the sternum. Therefore, the medical team has implemented a new technique, minimally invasive surgery through the right chest incision. The plus point of this method is that it makes a small incision, the patient does not have to see the sternum.

Through the right thoracic incision, the doctor used the Bentall method to replace the aortic root with valve graft number 27 and then reattached the 2 coronary holes. The surgery lasted for 6 hours. After this time, the patient was stable and stayed for 20 days and was discharged. At the follow-up visit after 3 months of surgery, the patient was in good health, walking normally.

According to the Cardiovascular Center of Cho Ray Hospital, the purpose of this surgery is to replace the ascending thoracic aorta and re-plug the two branches of the coronary arteries. The surgery was performed through 3 approaches: Semi-sternal opening, full-sternal opening, right anterior chest opening. This technique is quite difficult, requiring the team of surgeons to have high professional qualifications, skills and skills.

Before that, major cardiac centers and hospitals in Vietnam only performed Bentall surgery through partial or full sternotomy. This means that the minimally invasive Bentall surgery, right anterior thoracotomy at Cho Ray Hospital is the first successful case.

Hopefully the above sharing from SignsSymptomsList has helped you gain more useful knowledge about Bentall surgery . In Vietnam, Cho Ray Hospital is the first place that has successfully performed this surgery through minimally invasive route. This is a good sign for Vietnamese medicine. Because, this new step helps patients not to suffer much pain, not lose a lot of blood and shorten the recovery time.