Endo-Bentall repair: Early results and feasibility of a physician-constructed Endo-Bentall device

Abstract

Objective: We present our experience with the endovascular Bentall procedure (Endo-Bentall) using a modular valve conduit in high-risk patients with aortic root pathologies.

Methods: The physician-constructed Endo-Bentall device is composed of a self-expanding transcatheter aortic valve (TAVR), thoracic endovascular aortic stent graft (TEVAR), and 2 wire-reinforced fenestrations for coronary artery stenting. The TAVR valve is sutured into an appropriately sized TEVAR graft. The coronary fenestrations are made in the TEVAR graft based on computed tomography angiography measurements. The Endo-Bentall device is then resheathed within the TEVAR delivery system, advanced via femoral access, and deployed during rapid pacing. If persistent endoleak is present after device deployment, the coronary ostia are accessed and stented. No cardiopulmonary support is required.

Results: Five patients with prohibitive risk (mean age, 79 years; 4 with type A dissection and 1 with an aortic root aneurysm) underwent Endo-Bentall repair between November 2022 and October 2023. Severe aortic insufficiency was present in 2 patients preoperatively. The median back table modification time was 120 minutes (range, 55-150 minutes). The Endo-Bentall device was successfully implanted in all patients (100%). Two patients required concomitant total endoarch repair. In-hospital mortality was 0%. No patient experienced postoperative stroke. Three patients needed coronary stenting, and 1 patient required permanent pacemaker insertion. On follow-up computed tomography scan (at a median of 172 days; range, 63-368 days), no patient had a type 1a endoleak. No aortic insufficiency was present on follow-up transthoracic echocardiography.

Conclusions: Endo-Bentall repair using a single-stage valve-carrying conduit is feasible and effective, with encouraging early outcomes for highly selected patients with aortic root dissection or aneurysm who are considered not candidates for operation. Long-term follow-up data are needed to assess the persistence of the seal and ongoing durability of this novel technique.

Keywords: aneurysm; dissection; transcatheter aortic valve.