Bentall Procedure (Aortic Root Replacement)

This intricate surgery requires high-precision micro-stitching and is performed inside a specialized cardiac operating room under general anesthesia. The operation generally takes between 4 to 6 hours.

1. Surgical Access: The surgeon executes a standard median sternotomy, gently dividing the breastbone (sternum) to gain direct, open access to the heart and the ascending aorta.

2. Cardiopulmonary Bypass: The patient is connected to a heart-lung bypass machine, which takes over external oxygenation and circulation. The native heart is safely stopped, and a cooling solution is administered to preserve the heart muscle tissue.

3. Excision of Tissue: The surgeon opens the damaged ascending aorta, exposing the internal defects. The dilated, weak aortic root and the diseased native aortic valve are carefully cut out.

4. Coronary Artery Dissection: The openings of the left and right coronary arteries (which supply blood directly to the heart muscle) are precisely detached from the old aortic wall as small tissue "buttons" so they can be preserved.

5. Graft Implantation: A composite graft (comprising a new mechanical or bioprosthetic valve pre-attached inside a polyester tube) is customized to fit the anatomy. The base of this composite graft is meticulously stitched to the heart's native aortic ring.

7. Coronary Reimplantation: Small holes are created in the sides of the new synthetic tube graft. The preserved coronary artery buttons are carefully hand-stitched back into these holes, restoring vital blood supply to the heart muscle.

Distal Attachment and Closure: The top end of the tube graft is securely connected to the remaining healthy section of the ascending aorta. Once all connection seals are verified to be leak-free, the heart is safely restarted, the heart-lung machine is turned off, and the breastbone is wired closed.