Hugh bentall frcs 28 april 1920 9 september 2012 was a british surgeon who pioneered openheart surgery career. The mini bentall procedure consists of an aortic root and ascending aortic replacement with reimplantation of coronary buttons, performed via an upper hemisternotomy. Combined spinalepidural anesthesia for an elective cesarean. On july 20, 2015, a systematic literature search was conducted in embase, medline, the cochrane collaboration, and web of science. It may, however, be complicated by proximal stenosis of the reimplanted coronary arteries. In the bentall procedure, the durability of the av is deferred to prosthesis function. Clinical vignette a 43yearold woman was referred to our hospital with a diagnosis of severe aortic regurgitation and ascending aorta aneurysm video 1. Modifiedbentall procedure has become a gold standard in the treatment of combined aortic root and aortic valve diseases. Bentallgreenoak is a leading, global real estate investment management advisor and a globallyrecognized provider of real estate services. New modification of modified bentall procedure a single centre experience ghulam hussain1, naseem ahmad 2, sohail ahmad 3, mirza ahmad raza baig4, sara zaheer5, aamir furkan 6 abstract background and objectives. Apr 29, 2017 bentall operation became the preferred method of treatment for this kind of disease. The konno aortoventriculoplasty after the bentall procedure.
This operation is used to treat combined disease of the aortic valve and ascending aorta, including lesions associated with marfan syndrome. Concomitant bentall operation plus aortic arch replacement surgery. We herein report an emergency technique of composite bentall operation using a fast release valve. It is released solely for the purposes of communicating policies and procedures to the tenants of bentall centre. The speed and ease of execution are the main advantages of the procedure. This chapter provides a brief overview of the bentall procedure and focuses on the technical aspects of the minibentall procedure. This is translating into a weaker global growth forecast of 2. In contrast, during the last 5 years, the bentall operation represented 49. Individual surgical strategy must be developed since a general standard of such procedure does not exist. Minibentall procedure annals of cardiothoracic surgery.
The bentall procedure in ascending aortic aneurysm. Bentall patients probably reflects the preferential use of the bentall procedure for higher risk patients. Haemorrhage through a porous graft, and through stitch holes, is contained until reversal of heparin. Your aortas role is to carry oxygenrich blood from your heart to the rest of your body. This article is from yonsei medical journal, volume 53. At operation, cardiopulmonary bypass was established through the right axillary artery. The evidence in a bentall procedure with valsalva graft. Leadership with a perspective institutional investor. Their inclusion criterion was a bentall procedure with biological prosthesis.
We retrospectively identified all patients with ie who underwent bentall operation in our institution between august 2005 and june 2016. The bentall procedure is a type of cardiac surgery involving composite graft replacement of the aortic valve, aortic root, and ascending aorta, with reimplantation of the coronary arteries into the graft. Aortic root replacement bentall operation or aortic valve sparing david operation are alternative surgical techniques for the treatment of aortic root aneurysm. The bentall procedure has led the way for the development of other techniques for root replacement, such as aortic valvesparing procedures. Comparing outcomes between valvesparing root replacement. We report the case of a 45yearold woman who underwent simultaneously modified bentall procedure and orthotopic liver transplantation. Total proximal anastomosis detachment after classical bentall. A bentall operation is conducted to correct problems associated with the aorta. However, the data clearly indicate that emergency operation and clot have a negative impact on inhospital and longterm outcome.
The technique was successfully performed in 2 emergency cases after failed supracoronary ascending aortic replacement in acute type a aortic dissection. A simple modified bentall technique for surgical reconstruction of the aortic root short and long term outcomes. Minibentall procedure yan annals of cardiothoracic surgery. The choice between a biological or mechanical valve is complex, and patients should discuss. He remains in both public and private practise and is a member of the royston hospital clinical advisory committee. Studies dedicated to ie after bentall surgery are seldom undertaken, and usefulness of these new imaging modalities has not been specifically evaluated. Based on transthoracic echocardiography tte and transesophageal echocardiography.
The technique described in this chapter describes the details of the authors technique and variations for specific pathology. The right operation, for the right indication, that is well executed helps ensure clinical success. It involves replacement of the root and aortic valve with a graft and either a biological or mechanical valve prosthesis. Altogether, between 1986 and 1996, the bentall operation was used in 31. Journal of the egyptian society of cardiothoracic surgery. A few weeks before the bentall surgery, you can expect your doctor to tell you to stop a few medications. His body surface area at the bentall operation was 1. The others received a bentall operation plus total arch replacement along with elephant trunk. The potential advantage of these procedures is freedom from the need for anticoagulation and consequent low morbidity.
Distal anastomosis was performed after endarterctomy of the calcified plate, which allowed us to complete the bentall procedure without the postoperative bleeding. The procedure involves the replacement of the aortic root base of the aorta and valve three flaps that ensure the oneway flow of blood from the heart to the aorta, and reimplantation of the coronary arteries that branch out from the ascending aorta. To this date we have already been confronted with the need for seven conventional valve rereplacements among our 243 bio bentall procedures. The minibentall procedure encompasses aortic root and ascending aorta replacement with reimplantation of coronary buttons, performed via a ministernotomy. The composite graft was placed at the intraannular position inside of the preserved leaflets. Bischoff, md, carol bodian, drph, fabian roder, ms. The forecast does not call for recession, but it reflects a marked slowdown from average annual. View or download all content the institution has subscribed to. Between 1999 and 2017, 89 patients with a mean age of 57. Modification of the bentall operation using the proximal. The bentall operation is a 40yearold standardized procedure for treating aortic valve diseases and aneurysms involving the aortic root. The aim of the current study was to compare our 30days mortality. A 32yearold immunocompetent man with recurrent fever and 5kg weight loss had a history of having undergone the bentall procedure due to.
The bentall operation is a favorable technique of aortic root replacement and can be applied to most cases in adult aortic root pathology. Our experience with the technique and short and long. Some of the problems that are resolved with the help of a bentall surgery include the following. Longterm outcomes of aortic root operations for marfan syndrome. We describe a simplified modification of the technique that tries to lessen the intraoperative time, improve homeostasis and miminize early and late complications. Hugh henry bentall was educated at seaford college and studied medicine at st bartholomews hospital in london. Pdf the bentall procedure in ascending aortic aneurysm.
Myocardial protection and cerebral protection is discussed. Bentall procedure in a patient with severely calcified. Find powerpoint presentations and slides using the power of, find free presentations research about bentall. The biovalsalva prosthesis allows the bentall operation to be used in patients whose aortic valve cannot be spared. Pearls and pitfalls cut well and sew well and the patient will do well. Interrupted horizontal mattress sutures 20 polyestel reinforced with pledgets were placed. In all cases, the valve prosthesis could be easily removed from the inside of the incised graft and successfully replaced by the new prosthesis, which was then placed through the graft incision and fixed at the annulus in the usual manner.
Revisiting bentall procedure for type a aortic dissection dicky a. Outcomes for patients suffering from schizophrenia have not improved since the victorian age and an increasing number of. The valved conduit procedure was a modified bentall operation where the aortic mechanical valve prosthesis was sutured into the graft at. Wartono,md harapan kita national cardiovascular centre harapan kita jakarta 2016 2. View the article pdf and any associated supplements and figures for a period of 48 hours. The button bentall procedure operative techniques in.
Thirty years ago bentall described a technique for composite aortic valve and root replacement with reimplantation of the coronary arteries. Late prosthetic valve endocarditis with mycobacterium tuberculosis. This may be lifethreatening and can be difficult to treat. The wellknown bentall operation has been accepted for several decades. Amy price is president and chief investment officer of bentall kennedy in the u. The procedure is performed through a 57 cm skin incision. In summary, the bentall s procedure is a well proven operation with excellent longterm results. Early and late results after david vs bentall procedure.
The bentall procedure has led the way for the develop ment of other techniques for root replacement, such as aortic valvesparing procedures. Around the same time, you can make a few preparations at home to plan your arrival after the surgery and accordingly arrange for a transport as well. This chapter provides a brief overview of the bentall procedure and focuses on the technical aspects of the mini bentall procedure. Richard bentall s critique of biological psychiatry there is little evidence that the biological approach to psychiatry is benefiting patients. Aug, 2008 we present a report on reinforcement of the proximal anastomosis during the bentall operation. This is likely due to concerns about the durability of av correction in vsrr. Firstinhuman endobentall procedure for simultaneous. The left main complication of the bentalls procedure.
Typically the native aortic root and aortic valve are replaced with a composite graft that comprises both ascending aortic and aortic valve grafts, to which the coronary arteries are anastomosed history and etymology. The strength of the operation lies in its wide applicability and reproducibility. Surgical mortality with the bentall procedure is similar to published results by other specialized. Behcets disease involved the root of aorta in the treatment. We retrospectively analyzed 28 years of experience with the bentall procedure in. In bentalltype procedures, the bleeding and dehiscence occurring around the coronary ostial anastomosis still remain major complications. A simple modified bentall technique for surgical reconstruction of the. We describe the endovascular management of a middleaged woman who developed a bleeding suprasternal fistula after conventional aortic valve replacement. Eighteen years of clinical experience with a modification of. Indication for combined cardiac surgery and orthotopic liver transplantation is rare and patients are at high risks. The well regarded county department store began as a drapery shop, founded by frank bentall in 1867. The bentall operation is considered the standard procedure against which to measure the outcomes of newer valvesparing approaches to aortic root disease.
Minibentall procedure encompasses aortic root and ascending aortic replacement. Aortic dissection during pregnancy is a critical event for both the mom and the fetus. The procedure used dacron composite graft with a mechanical valve st. The bentall operation is recommended for thoracic aortic dissection or aneurysm involving the aortic root. New modification of modified bentall procedure a single. Stephen commenced practice in hawkes bay in 1996 and for ten years, up until 2014, he was head of the orthopaedic department at hawkes bay hospital. Bentall centre management team is provided below section 1.
However, the vascular anastomosis, operation design, complicated surgery process, higher surgical risks, and characteristic of more complications, kept the overall mortality rate being high at around 10% 2,3. From 2004 to 2008, 26 consecutive, nonselected patients mean age at surgery. A case report mohammed abdelsalam menshawi, islam mohammed shehata. Abstract the bentall procedure technique has evolved to become a standardized, reliable procedure that can be performed for a variety of aortic vavle and aortic root pathology. Embolic and bleeding events after modified bentall. The choice of valve type does not affect early or late outcomes, as shown in the 50 to 70year age group.
They concluded that in addition to the potential benefit of the pseudosinuses of valsalva on the coronary flow after bentall operations. Development oecd leading indicators, having lost momentum over the past 12 months, reflect this cautious sentiment. All patients included in this study had a button bentall operation, a modi. Since its introduction in 1968, the bentall procedure has been the primary surgical. Bentall procedure is performed for the repair of ascending aortic root lesions. A comparison of bentall versus aortic valvesparing procedures read at the 95th annual meeting of the american association for thoracic surgery, seattle, washington, april 2529, 2015. As more patients do not accept or have contraindications to lifelong anticoagulation, the biological bentall operation is a good option for these patients, even though complex reoperations would then be required for bioprosthesis degeneration. Based in san francisco, amy has overall responsibility. A customized stent attached to a transcatheter valve was successfully used to treat the individual, this being the firstinhuman case of the promising endo bentall procedure.
In our opinion, the bentall procedure with a valved homograft conduit, similar to aortic valve replacement with a homograft, is a safe procedure and should yield excellent longterm results. Pdf bentall operation with valved homograft conduit. The bentall operation is considered the standard in the surgical treatment for aortic root aneurysm, with low mortality and very good long results. A bentall procedure is a cardiac surgery operation involving composite graft replacement of the aortic valve, aortic root and ascending aorta, with reimplantation of the coronary arteries into. Oct 26, 2015 since the first introduction of the bentall technique, several modifications have been proposed to improve patient outcomes and decrease intra and postoperative complications.
Aortic root replacement with a composite valvegraft is a surgical treatment for aortic root aneurysms with a diseased aortic valve. The patients included those with degenerative aortic valve disease, endocarditis, and aortic. The aortic wall was excised with a 5mm remnant, and aortic valve leaflets were preserved. Embolic and bleeding events after modified bentall procedure. Combined spinalepidural anesthesia for an elective cesarean section in a marfan patient with a history of bentall operation who developed an acute extensive aortic dissection. Sep 01, 2012 one patient who underwent the bentall operation with a homograft required a redo bentall operation due to homograft dehiscence and residual moderate aortic regurgitation. The bentall procedure is a surgery performed to correct defects of the aorta.
Although evidence on shortterm results suggested favorable outcomes after biological bentall operations, data beyond 5 years are limited and highlight the urgent need for further investigations with longer followup. One patient required reoperation for development of a coronary pseudoaneurysm 20 years after a bentall procedure had been performed using the inclusion technique. The company was formerly listed on the london stock exchange, but since 2001 has been owned by. We present a case report of combined spinalepidural anesthesia for aortic dissection stanford type b in a parturient woman with marfan syndrome at her 37th week of gestation and had a history of bentall procedure 3 years ago. Bentalls is a british department store chain with a branch in kingston upon thames. The patient was a 27yearold man who had undergone 3 cardiac operations.
This has translated into a weaker global real gdp growth forecast of 2. The bentalldebono operation is the technique of choice for aortic root replacement. Aortic root replacement bentalls procedure sydney heart. The skin incision extends from the angle of louis to the third intercostal space, usually measuring 57 cm in length, depending on the body size of the patient. This technique could be extremely beneficial for all patients requiring a classical bentall procedure, but with specific indications for a biological solution. Emergency fast bentall operation interactive cardiovascular. Technical modifications have been added to the original description, regarding.
The bentall procedure is a cardiac surgical operation involving composite. View and download powerpoint presentations on bentall procedure ppt. The mini bentall procedure encompasses aortic root and ascending aorta replacement with reimplantation of coronary buttons, performed via a ministernotomy. Late function of the pulmonary homograft conduit could not be evaluated because of the patients death 6 months postoperatively. Combined spinalepidural anesthesia for an elective. Surgeons performing the bentall procedure must be familiar with all existing modifications. It is a congenital disorder characterized by weakening of the aortic wall.
The calcified aorta was transected by an oscillating saw under hypothermic circulatory arrest. We present a report on reinforcement of the proximal anastomosis during the bentall operation. Longterm outcomes of aortic root operations for marfan. Bentall operation with biological conduits the annals of. In this video, the authors present their technique for aortic root replacement using a freestyle aortic root prosthesis and a dacron graft, thus achieving a biological bentall. A bentall procedure is surgery to help correct problems with your aorta. Combination of modified bentall procedure and orthotopic.