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At Manipal Hospitals in Mukundapur, Kolkata, our Cardiothoracic Vascular Surgery Department offers the Bentall procedure, a complex surgical operation designed to address significant issues with the aortic valve and the aorta. This procedure is typically recommended for patients with conditions such as aortic regurgitation, aortic stenosis, or aortic aneurysms, particularly when these issues involve both the aortic valve and the ascending aorta.
The Bentall procedure involves replacing the aortic valve and the affected portion of the aorta with a composite graft that includes a mechanical or biological valve and a synthetic tube. This operation is performed through an open-heart approach, which requires careful planning and precise execution to ensure optimal outcomes.
Our group of highly skilled cardiothoracic surgeons performs the Bentall treatment with the highest level of precision and care by utilising cutting-edge methods and modern equipment. From pre-operative evaluation and planning to post-operative recuperation and care, patient safety and comfort are our top priorities.
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If you have aortic difficulties, your doctor may consider the Bentall surgery. Some of the most prevalent complications for which your surgeon will recommend Bentall surgery are:
Aortic regurgitation - This occurs when your heart’s aortic valve doesn’t close properly, causing blood to flow backwards into the heart.
Marfan's syndrome: A genetic disorder that has weakened the aorta wall thickness since birth.
Aortic aneurysm: A widening or ballooning of the aorta that can lead to rupture if untreated.
Aortic dissection: A serious condition where the inner layer of the aorta tears, causing blood to flow between the layers of the aortic wall.
The Bentall procedure is commonly used to address issues with the aortic valve and the sinuses of the Valsalva. During this surgery, the damaged valve is replaced with one of two types: a mechanical valve or a bioprosthetic valve.
Approximately two weeks before your procedure, you will need to:
Check with your doctor about taking your medications; some may need to be stopped before surgery.
Arrange for someone to pick you up from the hospital and assist you with shopping, meals, cleaning, and driving.
You will need to have some crucial tests, such as an ECG, chest X-ray, blood tests, nose and groin swabs, and carotid dopplers.
Do not eat or drink anything after midnight before the surgery, unless instructed otherwise by your doctor.
Stop smoking at least two weeks before the surgery to improve lung function and healing.
Avoid alcohol and follow a healthy diet as advised by your healthcare provider.
A member of hospital personnel will clip off any hair from your chest, arms, legs, and groin to limit the possibility of infection.
Take a shower using antibacterial soap, which will be provided by the hospital.
Wear a hospital gown and remove all makeup, nail paint, and jewellery.
During Surgery:
Anaesthesia: General anaesthesia is used to keep the patient asleep and pain-free during the surgical operation.
A surgical incision is created, typically along the sternum (breastbone), to gain access to the heart and aorta.
You will be connected to a heart-lung bypass machine, which takes over the function of your heart and lungs during the surgery.
Removal of Damaged Tissue: A faulty aortic valve is removed. This procedure is required if the aortic valve is defective or malfunctioning.
Replacement: A composite graft, which includes a new aortic valve (mechanical or bioprosthetic) and an artificial section of the aorta, is sewn into place.
Coronary Arteries: The coronary arteries are reattached to the new graft.
The heart-lung machine is gradually removed as your heart takes over pumping blood. The incision in your chest is closed with sutures or staples.
The Bentall surgery, like other open-heart surgeries, contains inherent risks and is a significant intervention that, unfortunately, may not be survivable for everyone. Potential problems from the surgery include:
An irregular heart rate
Reduced cardiac output
Heart attack
Stroke with infections (e.g., sepsis, pneumonia, surgical wound infection)
Internal bleeding that may necessitate surgical treatment
Sudden renal failure can be temporary or permanent
Prolonged reliance on mechanical ventilation
The formation of a new aortic aneurysm or aortic dissection
Individuals with additional medical issues, such as diabetes, or those with extremely severe pre-existing heart diseases may be more likely to experience specific consequences.
Patients are routinely monitored in the intensive care unit for one to two days before being transferred to the nursing unit for four to five days. Two to three tubes remain in the chest to drain fluid from around the heart and are typically removed one to three days after surgery.
A full recovery often takes about two months. Most patients can drive three to eight weeks after surgery. Your surgeon will give you specific instructions for your recuperation and return to work.
After 4 to 6 weeks, you should be ready to resume most of your normal activities. However, for at least 6 weeks, you will be unable to move heavy things or engage in activities that strain your chest or upper arm muscles. At first, you may notice that you get fatigued quickly and need to rest frequently.
Valve-Sparing Aortic Root Replacement (Reimplantation) is an alternative to the Bentall procedure. It has various advantages over the Bentall operation, including:
Reduced likelihood of requiring another aortic valve procedure in the future.
There is no need for lifetime anticoagulant therapy.
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