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Learning About the Bentall Procedure

Bentall procedure, showing the heart, the coronary artery, and detail of the section of the aorta that has been replaced.

What is the Bentall procedure?

The Bentall procedure is a surgery to replace part of the aorta and the aortic valve of the heart because of a bulge (aneurysm) in the aorta.

The aorta is the large blood vessel (artery) that carries blood from the heart through the chest and belly to the rest of the body. The aortic valve, which is at the base of the aorta, lets blood flow from the heart into the aorta. An aneurysm can change the shape of the aortic valve and keep the valve from working as it should.

Why is it done?

The Bentall procedure replaces a part of the aorta damaged by an aneurysm. It also replaces the aortic valve that isn't working.

A large aneurysm in the aorta can be very dangerous. If it bursts, it can cause bleeding that leads to death.

An aneurysm in the ascending aorta (which rises out of the heart) also can cause the base of the aorta (called the aortic root) to widen. This change in shape can cause the aortic valve to not work right. If the valve can't close properly, blood can leak backward into your heart. This is called aortic valve regurgitation. This leaking can cause the blood to build up too much pressure in the heart.

How is it done?

You will be asleep during the surgery, which may take about 5 to 6 hours. The doctor will make a large cut in your chest. This cut is called an incision. It will be made through the breastbone (sternum).

During the surgery, the doctor will likely connect you to a machine that does the jobs of your heart and lungs. It's called a heart-lung bypass machine. This machine lets the doctor stop your heartbeat while they work on your aorta and aortic valve.

The doctor will put a clamp on the aorta above the aneurysm. This stops blood from flowing back into the aneurysm. The doctor will remove the weak section of the aorta and the aortic valve. The doctor will replace that part of the aorta with a man-made tube called a graft. Inside of this graft is an artificial aortic valve. The valve might be mechanical or made of biological tissue.

The doctor will sew one end of the graft to your healthy aorta and sew the other end (with the valve) onto the heart. The doctor also sews two coronary arteries into the graft. These arteries used to be connected to the aorta.

After the aorta and aortic valve are in place and sealed, the doctor will remove the clamp.

The doctor will restart your heartbeat and disconnect the heart-lung machine.

The heart can then pump blood through the aortic valve and into the aorta again. Then the doctor will use stitches or surgical staples to close the incision in your chest.

What can you expect after the surgery?

You will likely spend a few days in the hospital. You will probably go to the intensive care unit (ICU) after surgery. You may stay in the ICU for 1 or 2 days before you go to your regular hospital room.

For at least 6 weeks after you go home, avoid lifting anything that would make you strain. You may need to take a few weeks off from work. It depends on the type of work you do and how you feel.

You will feel tired and sore for the first few weeks after surgery. You may have some brief, sharp pains on either side of your chest. Your chest, shoulders, and upper back may ache. The incision in your chest may be sore or swollen. These symptoms usually get better after 4 to 6 weeks.

You will probably be able to do many of your usual activities after 4 to 6 weeks. At first you may notice that you get tired easily and need to rest often. It may take 1 to 2 months to get your energy back.

After surgery you may need to take a medicine called a blood thinner. It prevents blood clots. If your doctor prescribes a blood thinner, it's very important to take the medicine exactly as directed.

Be sure to tell all your doctors and your dentist that you've had heart valve surgery. This is important, because you may need to take antibiotics before certain procedures to prevent infection.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

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