When it comes to heart surgery, one of the most cutting-edge and life-saving operations is the Bentall procedure. If you or a loved one has been informed that they need this surgery, it’s totally understandable to feel confused. But don’t worry, this blog will take you through everything you need to know in plain, easy-to-grasp terms.
From what the Bentall procedure is, who requires it, and how it’s performed, to what recovery is like after surgery, let’s start.
What is the Bentall Procedure?
The Bentall procedure is a complex heart procedure that is used to treat severe conditions of the aortic root and aortic valve. These components of the heart are vital in ensuring proper blood circulation from your heart to the rest of the body. When there’s a problem, such as a bulging aorta (aneurysm) or a leaky valve, it can endanger your life.
Individuals with diseases such as Marfan syndrome, aortic aneurysm, aortic valve disease, or even aortic dissection (a tear in the aorta) usually need to undergo this procedure.
But what exactly is this procedure? Let’s break it down.
The Bentall operation is a form of open-heart surgery in which the aortic valve, aortic root, and ascending aorta are replaced, all at once. In medical language, this is referred to as a “composite graft replacement.” The operation was initially proposed in 1968 by Dr. Hugh Bentall and colleagues in London. The aim was to develop a single operation for patients with both valve and aortic root disease.
Here’s why it stands out:
- A mechanical or biological valve replaces the diseased aortic valve.
- A synthetic graft replaces the dilated or diseased portion of the aorta.
- The coronary arteries are reimplanted in the graft, and normal circulation to the heart is restored.
It’s similar to replacing a broken pipe and valve system inside your house, all at once, and with new equipment.
Who is a Candidate for the Bentall Procedure?
The Bentall surgery is used for individuals who have life-threatening aortic disorders. Let’s review some typical reasons:
Aortic Root Aneurysm
This is a ballooning or bulging of the aorta close to the heart. If left unchecked, it may rupture and lead to instant death.
Aortic Valve Disease
Conditions such as regurgitation (leaky valve) or stenosis (narrowed valve) interfere with the heart’s pumping of blood effectively.
Connective Tissue Disorders
Conditions such as Marfan syndrome and Loeys-Dietz syndrome weaken the aorta and cause tearing or ballooning.
Aortic Dissection
This is a life-threatening condition in which a tear occurs in the aorta’s wall and needs to be corrected with an immediate operation.
How is the Need for a Bentall Procedure Diagnosed?
To check if you require a Bentall procedure, your physician will perform a number of tests:
- Echocardiogram (Echo)
- CT or MRI of the chest
- Angiography
These serve to check for the size of your aneurysm, the health of your valve, and the overall function of your heart.
What are the Different Types of Bentall Procedures?
There are several variations of the Bentall procedure, depending on your case:
Classic Bentall Procedure
The early method was to suture the coronary arteries to the graft directly. It was more complicated to do, though.
Modified Bentall Procedure (Button Technique)
This is now more frequently performed, where the coronary arteries are fixed in place as “buttons,” making leakage and complications less likely.
Valve Options
There are 2 types of valve options available:
- Mechanical Valve: Long-lasting, but needs lifelong anticoagulation (such as with warfarin).
- Bioprosthetic (Tissue) Valve: Made from animal tissue. Doesn’t usually need lifelong blood thinners but may wear out in 10–15 years.
Valve-Sparing Alternatives
In selected patients, a valve-sparing procedure like the David procedure may be considered. This preserves your natural valve while replacing the aorta.
Preoperative Evaluation
Before undergoing the Bentall surgery, a thorough assessment is essential. Common pre-surgery tests include the following:
- Blood tests
- Chest X-ray
- CT scan or MRI
- Cardiac catheterization
- Echocardiography
You will also meet with a cardiologist, anesthesiologist, and surgeon to ensure you are fit for surgery. Choosing an experienced cardiac surgeon and a well-equipped hospital can greatly impact your outcome.
Step-by-Step Overview of the Bentall Surgery
Wondering what happens during the procedure? Here’s a step-by-step guide:
- Anesthesia & Incision: You will be under general anesthesia. A vertical cut is made along the chest (sternotomy) to access the heart.
- Cardiopulmonary Bypass: A heart-lung machine performs your breathing and circulation during surgery.
- Removal of Diseased Tissue: The diseased aortic valve, aortic root, and ascending aorta are removed by the surgeon.
- Graft & Valve Placement: A synthetic graft combined with a valve is stitched in place.
- Coronary Artery Reimplantation: The coronary arteries are re-implanted back to the graft (button technique).
- Completion & Recovery: The chest is closed after ensuring that everything functions properly.
The whole surgical process usually takes 4 to 6 hours.
Recovery After Bentall Procedure
Recovery is progressive and can be different from individual to individual.
Hospital Stay
- ICU stay for 1–2 days for intense observation
- A total hospital stay of 7 to 10 days
Medications
- Anticoagulants (blood thinners) for mechanical valves
- Blood pressure medications and pain relief medication
Physical Recovery
- Light activities after 4–6 weeks
- Complete recovery may take 6 to 12 weeks
- Cardiac rehab advised to regain strength
Follow-Up
Routine doctor check-ups and tests (such as echocardiograms and blood tests) are essential to watch for valve function and the level of clots in the blood.
What are the Risks and Complications of the Bentall Procedure?
As with any serious surgery, the Bentall surgery has some risks. Luckily, with skilled treatment, the majority of individuals recover nicely. Possible risks include the following:
- Bleeding
- Infection
- Stroke
- Irregular heartbeat (arrhythmia)
- Blood thinning (particularly with mechanical valves)
Mechanical valve users must be extra cautious as blood thinners are required for life. Skipping them can lead to dangerous clots. However early detection and regular follow-up significantly reduce these risks.
Life After the Bentall Procedure
Most individuals lead active, healthy lives following the operation; particularly if they follow medical recommendations.
Long-Term Survival
- Excellent long-term survival rates when detected and treated early.
- Numerous patients return to work and normal activities in several months.
Lifestyle Modifications
- Consume heart-healthy nutrition (low salt, low fat).
- Exercise on a regular basis (following medical clearance).
- Smoke cessation and moderate alcohol.
- Adhere to medications as directed.
Cardiac Rehabilitation
- This supervised program comprises monitored exercise, education, and counseling to recover quicker and prevent future heart problems.
What is the Cost of the Bentall Procedure in India?
The cost of the Bentall procedure in India can vary widely based on the hospital, location, and individual patient circumstances. Generally, costs range from USD 5,000 to USD 10,000. This often includes expenses for hospitalization, fees for the surgeon and anesthetist, as well as post-operative care and medications. Cities such as Mumbai, Delhi, and Bangalore may have higher costs due to their advanced medical facilities and experienced medical staff. It’s essential for patients to explore and consult multiple healthcare providers to identify the most suitable options that align with their needs and budget.
The cost of the Bentall procedure in India is quite affordable when compared to other nations.
| Country | Cost |
| India | USD 5,000 – USD 10,000 |
| Turkey | USD 10,000 – USD 15,000 |
| UAE | USD 18,000 – USD 25,000 |
| USA | USD 70,000 – USD 120,000 |
Most estimates of costs include:
- Hospital stay (ICU + regular room)
- Surgeon and anesthetist fees
- Operation theatre charges
- Pre- and post-op investigations
- Medications and consumables
For international patients, medical tourism facilities can organize packages with travel, lodging, and language assistance.
Conclusion
The Bentall procedure is a strong surgical treatment for individuals who have life-threatening aortic and valve diseases. Although it’s a complex operation, advanced methods, and skilled surgeons have rendered it much safer with excellent long-term results.
If you or a friend has been diagnosed with an issue in the aortic root, panic not. Consult EdhaCare and we will get you in touch with the top cardiothoracic surgeons proficient in the Bentall procedure. Early diagnosis, a proper medical staff, and adequate aftercare are all that you require.
Frequently Asked Questions (FAQs)
Is the Bentall procedure a high-risk surgery?
It’s a major surgery, but with skilled surgeons and modern technology, the success rate is high. Risks are minimized when performed at experienced centers.
How long does it take to recover from the Bentall procedure?
Most people recover in 6 to 12 weeks, but full strength may return gradually over several months.
Can I live a normal life after the Bentall surgery?
Yes! With proper care, medication, and follow-ups, most patients live a full, active life after surgery.
What is the difference between Bentall and valve-sparing surgery?
The Bentall procedure replaces the valve and aorta, while valve-sparing procedures (like the David procedure) preserve the patient’s own valve.
Do I need lifelong medications after Bentall surgery?
If you have a mechanical valve, then yes, you will need lifelong blood thinners. With a tissue valve, you may avoid long-term anticoagulation.