The Bentall-de Bono Procedure: A Novel, Time-Efficient Mattress-Type Technique for Aortic Root Anastomosis

One of the major challenges of the Bentall-de Bono procedure is achieving proper hemostasis. Several techniques have been previously described for managing the aortic root, such as the French Cuff or the use of double suture layers. This technique is remarkably fast, completing the procedure with only 72 minutes of aortic cross-clamping and using a single suture line, both outside-in and inside-out. This approach passes through the valved graft to create a mattress-type layer, providing excellent hemostasis at the root. Root bleeding is one of the greatest challenges a surgeon can face during a Bentall procedure; however, after several years of applying this technique, the authors have not encountered a single case. It is an excellent strategy to use in aneurysms and especially in dissections, where the tissue is often extremely fragile. The result is aesthetic, hemostatic, and fast, and it has become the standard in the authors’ practice. Additionally, the video demonstrates how to anastomose the coronary buttons using polytetrafluoroethylene (PTFE) pledgets to further enhance hemostasis. This video is especially valuable for surgeons working in centers with lower aortic volumes, as it presents a safe and efficient surgical technique. 

References

1. Yan TD. Mini-Bentall Procedure: The "French Cuff" Technique. Ann Thorac Surg. 2016 Feb;101(2):780-2. doi: 10.1016/j.athoracsur.2015.06.092. PMID: 26777944.

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