Ascending Aortic Aneurysm can often be accompanied by aortic root dilation. This condition usually occurs with aortic valve insufficiency or serious stenosis in the aortic valve may have dilated the aortic root in the late stage. Regardless of the reason, the replacement of the dilated aortic root with the valve is called the Bentall Surgery. This procedure, first described and applied by Bentall in 1968 ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC47179… ), is among the complex operations of cardiac surgery. Because there is not only an aortic aneurysm here. As you can see in the picture below, the Aortic Aneurysm has now spread to the aortic root. In the aortic root, there are the aortic valve and the arteries that feed the heart, namely the Coronary Arteries. These have also fallen into the dilation and therefore entered the surgical field. The aortic root generally has a thin-walled structure and expands towards the wide curvature (large angled part) of the aortic vessel. The most feared complication of aortic aneurysm is the bursting (rupture) or tearing inwards (dissection). For this reason, the ascending aortic vessel that reaches a certain diameter must definitely be replaced with surgical treatment. Today, no interventional treatment (i.e. other non-surgical methods) has yet been found for aneurysms in this position of the aorta.

When the diameter of the dilated aorta is >= 55 mm, surgery is absolutely necessary according to the Cardiovascular Surgery Guidelines. However, in some special cases, when the diameter is >= 50 mm, in cases with labile hypertension and/or Marfan Syndrome, in cases with connective tissue laxity, in cases with such genetic disorders, there is a potential increase in risk, so early preventive surgery is definitely indicated ( http://vascular-endovascular-surgery.imedpub.com/c… ).

Aortic aneurysm detection is easiest with echocardiography. However, diameter measurement with high-resolution computed tomography is still considered the most important diagnostic method. MRI and Angiography can also be used for diameter measurement.

In the Bentall Surgery, which is among the complex operations of Cardiovascular Surgery, the dilated Ascending Aorta is completely resected (removed), as seen in the figure. While the resection is extended to the Aortic Root, the Coronary Arteries (vessels that feed the heart) coming from here are separated from their origins and prepared to be sewn back together.

The aortic valve is completely resected. In other words, in these cases, the aortic valve is usually not suitable for repair, it is stenotic or the valve leaflets are no longer suitable for repair due to insufficiency. Therefore, valve replacement has become a necessity. This is a situation we often observe in bicuspid (two-leaf) valves.

As seen in the figure, after the aortic valve is replaced with either a biological or metal (mechanical) valve, the entire dilated aorta, including the aortic root, is replaced with a “Graft” made of artificial material. Some companies have produced ready-made grafts with valves and these can be used for the Bentall Surgery. After these procedures, as seen in the figure, “Re-Implantation” of the Coronary Arteries is applied, that is, the vessels that feed the heart are sewn back to the “new aorta”, that is, to the graft.

All these procedures require serious precision, complete attention and command of geometry. Because in cases of crooked, faulty suturing or inadequate suturing of the coronary arteries, the heart’s nutrition may be disrupted and complications that may lead to serious consequences may occur. This is the most important step that makes the Bentall Surgery complex.

The results of the surgery are generally quite satisfactory in good hands. Surgical Mortality varies between 1% and 12% in the literature. Bentall Surgery can also be performed through very small incisions, as in the picture of the article. Considering the difficulty of the surgery, the smallness of the incision seems to be a very useful method in terms of preventing bone-related complications and patient satisfaction/psychology, without affecting the general cosmetics of the patients, by minimizing the bone cut.

Bentall Surgery is a preventive treatment method; It protects patients from Heart Failure and Aortic Rupture. Small Incision (or Armpit Heart Surgery in public) is included in preventive treatment methods due to the movement of the sternum bone after the surgery, less infection and positive effects on the patient’s psychology.