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History. 1956 Debakey et al : 6 aortic dissectionMyron Wheat , Jr: medical therapy1967 Houston group successfully excised an arch aneurysm and replace with a homograft1968 Bentall and De Bono :replacement of ascending aorta and aortic valve. Pioneer . Homograft replacement of the ascending aorta. Drawings showing final anastomosis of homograft to base of ascending aorta (DeBakey).
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1. Bentall operation A technique for complete replacement of the ascending aorta
Hugh Bentall and Antony De Bono
Royal Postgraduate Medical Scholl, London, and Hammersmith Hospital
3. Pioneer Homograft replacement of the ascending aorta. Drawings showing final anastomosis of homograft to base of ascending aorta (DeBakey)
4. Indication AR, dilated aortic root( 5cm)
Marfans syndrome
Dissection aortic aneurysm
5. Procedure Establish cardiopulmonary bypass
cross-clamping the aorta distal to the aneurysm
suture the tube prosthesis directly to the Starr valve
Excise aortic cusps
suture were placed in the aortic ring and through the Starr valve ring, fixed.
6. Procedure
7. Procedure Holes are cut in the aortic prosthesis at the site of the coronary ostia
The aortic wall was sutured to the perimeter of the holes, reincorporating the coronary ostia with the new aorta
complete the distal anastomosis
8. Procedure
9. Discussion Deep hypothermia cardiac arrest ( 15-18 without clamp, 45 mins)
retrograde cardioplegia
pseudo-aneurysm caused by wrapping
residual AR
Resuspension of aortic valve