Mini Bentall operation: technical considerations

Abstract

Bentall operation via median sternotomy has been largely shown to be safe and long-term efficacious and currently represents the "gold standard" intervention in patients presenting with aortic valve and root disease. However, over the last years, minimally invasive techniques have gained wider clinical application in cardiac surgery. In particular, minimally invasive aortic valve replacement through ministernotomy has shown excellent outcomes and becomes the first choice approach in numerous experienced centers. Based on these favorable results, ministernotomy approach has also been proposed for complex cardiac procedures such as aortic root replacement and arch surgery. Herein, we present our technique for minimally invasive Bentall operation using a ministernotomy approach.

Keywords: Aortic root surgery; Bentall operation; Minimally invasive techniques.

Fig. 1

a Operative setup. Prior to skin incision, the positions of the jugular notch, the sternal midline (from the angle of Louis to just above the 4th intercostal space), and the xiphoid are marked. b Cardiopulmonary bypass is established by means of standard central cannulation sites (proximal arch and right atrium)

Fig. 2

Valve conduit implantation. The graft is sutured to the aortic annulus using 2-0 interrupted U-sutures with Teflon pledgets on the aortic side (a). The same stitches are then passed through the sewing ring of the composite graft (b)

Fig. 3

Right coronary artery re-implantation. An appropriate hole for coronary button re-attachment is made in the Dacron graft (a), and a parachute anastomosis is performed with a 5/0 polypropylene running suture (b)

Fig. 4

The valve conduit is anastomosed to the distal aorta with a continuous 4-0 polypropylene running suture (a), incorporating an external Teflon felt strip, using parachute technique (b)

Fig. 5

Final result