Bentall-de Bono Procedure and Aortic Reconstruction During DHCA with u-ACP

The patient presented in this video is a sixty-eight-year-old female who had undergone coronary artery bypass grafting (CABG) in 2020 and percutaneous coronary intervention in 2023. In this case, the Bentall-de Bono procedure with concomitant hemiarch replacement was performed during circulatory arrest with moderate hypothermia at 25 degrees Celsius. Cannulation was performed through the subclavian artery for unilateral cerebral perfusion. The venous line was then placed through the right femoral vein. A computed tomography (CT) scan revealed a thrombosed false aneurysm cavity, which was compressing the left atrium, and DeBakey type II chronic aortic dissection.

As soon as median sternotomy was performed, the pericardium was fixed with several stay sutures. Branches of the aortic arch were isolated from surrounding tissue and taken on holders. Aortotomy was completed after the patient was cooled to 25 degrees Celsius. A circular tear was found on the posterior wall and the cavity was partially filled with thrombus. After noting the rupture, the aortic valve was examined. The leaflets and annulus were severely calcified. The decision was made that valve-preserving surgery was not an option. 

Next, direct selective cardioplegia into the coronary artery orifices was performed. A Foley catheter from the aortic line was placed into brachiocephalic trunk for unilateral cerebral perfusion (1). The next step was to place a left ventricular drain. Circulatory arrest was started and “hemiarch” type distal anastomosis was performed between the vascular prosthesis and the proximal aortic arch. Antegrade cerebral perfusion and circulatory arrest were completed. The aortic root was mobilized, aortic valve leaflets were resected, and the coronary arteries were isolated and taken on holders. A Dacron valved conduit consisting of a biological valve prosthesis was placed using the “French Cuff” technique (2). A suture was placed for reliable hemostasis. 

In the final stage of the procedure, coronary buttons were reimplanted according to the Kouchoukos technique. An interprosthetic suture was also performed. Deaeration was then performed and epicardial pacing wires were fixed.

The postoperative period passed without any complications. The patient was in the intensive care unit for three days and discharged according to the postoperative period.

References

1. Karadzha, Anastasiia, et al. "The Bio-Bentall procedure with concomitant hemiarch replacement through a right anterolateral minithoracotomy." Multimedia Manual of Cardiothoracic Surgery: MMCTS 2022 (2022).
2. Yan, Tristan D. "Mini-Bentall procedure: the “French cuff” technique." The Annals of Thoracic Surgery 101.2 (2016): 780-782.

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