Minimally Invasive Bentall Procedure

This video is part of CTSNet’s 2024 Resident Video Competition. Watch all entries into the competition, including the winning videos.   

In this video, the authors discuss a minimally invasive Bentall procedure performed for an aortic aneurysm. 

A 54-year-old male presented to the outpatient department with a chief complaint of breathlessness persisting for four to five months. Upon investigation, he was diagnosed with severe aortic regurgitation, a dilated ascending aorta measuring 8 cm, and a dilated aortic root, as revealed by 2D echocardiography. After a thorough evaluation, the surgeons planned and proceeded with a minimally invasive Bentall procedure. 

A 5-6 cm incision was made in the right second intercostal space. The incision was deepened layer by layer, reflecting the pectoralis major muscle. The right lobe of the thymic fat was exposed and dissected to visualize the pericardium. The phrenic nerve was identified, and the pericardium was opened 2-3 cm above the nerve to avoid any injury. Pericardial stay sutures were placed to improve exposure of the aorta, and meticulous hemostasis was achieved. 

A 2 cm incision was then made in the right femoral region, and the femoral vessels were exposed. Peripheral cannulation was performed using the Seldinger technique, establishing cardiopulmonary bypass. A left ventricular vent was inserted via the right superior pulmonary vein to decompress the heart and prevent distension. 

Following vent insertion, the aorta was cross-clamped with a straight clamp and opened. Antegrade cardioplegia was administered directly into the coronary ostia to arrest the heart. The bicuspid aortic valve was excised using a surgical knife, aortic sutures were taken, and the annulus was sized. Additional cardioplegia was administered to maintain myocardial protection. 

Coronary button harvesting commenced, with both the left and right coronary buttons successfully harvested. Sutures were placed on the aortic annulus, and a suitable conduit was selected. Sutures were passed through the conduit, which was then positioned and secured to the annulus. The left coronary button was reimplanted onto the conduit using 8-0 polypropylene sutures. 

The distal anastomosis of the conduit to the aortic end was performed in a continuous fashion with 5-0 polypropylene. The right coronary button was then reimplanted onto the conduit and secured. Deairing was meticulously performed using needles placed in the conduit, and the aortic clamp was subsequently removed. 

After de-airing, the pulmonary vein vent site was secured with 4-0 polypropylene sutures. Decannulation of the femoral artery and vein was completed, and hemostasis was ensured. The pericardium was partially approximated, and a right pleural drain was inserted. Chest and femoral wound closures were performed in a routine fashion. 
The patient was successfully shifted to the postoperative ICU for further monitoring and care. 

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.