The (Bentall) Procedure

Posted: 10 Apr 2023
Updated: 11 Apr 2023

So, I’m not really sure that I can advocate for watching the surgery on YouTube before you go through it, but, I did and here we are. I’ll attach below a couple of videos – the first is an animated explainer, and the second is a for-real-no-joke actual Bentall Procedure which is almost the exact one I’ll be having (or have had, depending on when you read this). The animated video doesn’t go into the aortic root replacement that I’ll be getting, but it’s a great video.

1. Make a skin incision along the full length of the sternum.
2. Use a bone saw to separate the sternum along its median.
3. Retract the sternum and lungs.
4. Open the pericardium (sac around the heart) with a diathermy¹ (an absolutely wild tool).
5. Cannulate the right atrium and the ascending aorta for cardiopulmonary bypass.
6. Cool the heart and then temporarily arrest the heart (stop it beating), so surgery can be more easily performed².
7. Clamp the aorta to prevent backflow.
8. Transcet (cut) the aorta.
9. Remove the defective aorta and valve.
10. Prepare many sutures on the annulus.
11. In some surgeries the valve may then be attached to the annulus these sutures before being attached to the repalcement aorta. In the video below the valve is pre-attached to the graft. I believe in mine will be the prior.
12. “Parachute” the valve/graft into place.
13. Attach the coronary arteries to the graft. These were previously attached to the aorta and are the ones that can get blocked with plaque and cause heart attacks!
14. Attach the top of the graft to the rest of the ascending aorta.
15. Remove air from the aorta and graft.
16. Sometimes an irregular heart rhythm will occur – this can be very serious. Patients may have a pacemaker or temporary pacing-wire inserted at this stage (hopefully not).
17. Take the patient off the cardiopulmonary bypass machine.
18. Insert a pericardial drainage tube to let excess fluid from around the heart drain out after the surgery.
19. Check you didn’t leave any tools inside the patient (it’s happened before)³.
20. Close the sternum using wires. These can be removed post-recovery if the patient has discomfort from their presence.
21. Suture the tissue closed, tidy up and take the patient to ICU!
22. It may take some time (two to four hours) before the team are happy to take you off the ventilator. They will wake you up from the anasthetic and remove the tube once your breathing is returning.
23. The recovery begins!