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Bentall operation on beating heart technique

Background: In 1968, Bentall proposed the artificial vessels with ascending aorta and aortic valve replacement and re-implantation of left and right coronary arteries to treat aortic disease with ascending aortic aneurysmal dilatation. Successful Bentall operation can be achieved by greater myocardial protection, no distortion and unobstructed coronary artery bypass grafting, as well as ensured anastomotic stoma.

Patients and Methods: From June 2007 to November 2013, 421 consecutive patients with a variety of cardiac pathologies underwent beating heart surgery at our institution utilizing the myocardial perfusion strategies described above. Among them, 21 cases underwent beating heart Bentall surgery, the etiology of patients was Marfan syndrome (5 patients; 23.8%), degenerative disease (2 patients; 9.5%), bicuspid aortic valve (2 patients; 9.5%), Takayasu’s arteritis (1 patient; 4.8%), and rheumatic disease in the remaining 11 patients (52.4%). Surgical Technique: Surgical procedures were performed and valve was resected, and sutured with artificial blood vessels with valve in continuous or interrupted sutures manner in aortic rings.

Results: None of the patients had perioperative myocardial infarction. Major complications included low output syndrome in 1 patient (4.8%), need for prolonged mechanical ventilation in 2 (9.5%). Postoperative echocardiographic data were available for 17 of 21 patients (81.0%). 17 patients were evaluated; none of the patients had peri valvular leak or prosthetic valve dysfunction.

Conclusion: Bentall operation can improve the functional recovery and quality of life in most of the surviving patients. Outcomes obtained using warm blood retrograde coronary sinus perfusion in beating heart surgery seems to compare favorably to those of traditional cardiac arrest surgery.

Author(s): Durgendra Bikram Maghaiya, Geng Zhi Min, Yan Yang