Ascending aorta graft, with cardiopulmonary bypass, with aortic root replacement using valved conduit and coronary reconstruction (eg, Bentall)
CPT4 code
Name of the Procedure:
Ascending Aorta Graft with Cardiopulmonary Bypass and Aortic Root Replacement using Valved Conduit, and Coronary Reconstruction (Bentall Procedure)
Summary
The Bentall Procedure involves replacing the aortic root and ascending aorta using a synthetic graft equipped with a valve. This surgical procedure also includes re-attaching the coronary arteries. It is typically performed under cardiopulmonary bypass.
Purpose
This procedure addresses severe conditions affecting the aorta such as aneurysms, dissections, or severe valve diseases. The goal is to replace the damaged sections of the aorta and valve to restore normal blood flow and prevent life-threatening complications.
Indications
- Aortic aneurysm
- Aortic dissection
- Severe aortic valve regurgitation or stenosis
- Congenital aortic valve abnormalities
- Patients with genetic conditions like Marfan syndrome
Preparation
- Fasting for at least 8 hours before surgery
- Medication review and possible adjustments
- Pre-operative tests, including blood work, imaging studies (CT scan, echocardiogram), and EKG
- Consultation with the surgical and anesthesia team
Procedure Description
- The patient is placed under general anesthesia.
- Cardiopulmonary bypass is initiated to take over the function of the heart and lungs.
- The surgeon removes the diseased portion of the ascending aorta and aortic root.
- A synthetic graft with a built-in valve is implanted in place of the removed sections.
- The coronary arteries are reattached to the graft.
- The heart is gradually restored to normal function, and the cardiopulmonary bypass is discontinued.
- Incisions are closed, and the patient is taken to the ICU for recovery.
Duration
The procedure typically takes 4 to 6 hours.
Setting
The procedure is performed in a hospital operating room.
Personnel
- Cardiothoracic surgeon
- Anesthesiologist
- Surgical nurses
- Perfusionist (to operate the cardiopulmonary bypass machine)
- Critical care team for post-operative care
Risks and Complications
- Bleeding
- Infection
- Stroke
- Myocardial infarction (heart attack)
- Kidney failure
- Blood clots
- Valve-related complications
- Death (in rare cases)
Benefits
- Correction of life-threatening aortic conditions
- Restoration of normal blood flow and function
- Reduction of risks associated with untreated aortic disease
- Enhanced quality of life post-recovery
Recovery
- Initial hospital stay of 7 to 10 days, with ICU care for the first 24-48 hours
- Gradual return to normal activities over 6 to 8 weeks
- Pain management and medications to prevent blood clots
- Follow-up appointments to monitor heart function and graft integrity
Alternatives
- Non-surgical management (limited to cases where surgery is too risky)
- Endovascular stent grafting (for certain types of aortic aneurysms)
- Valve-sparing aortic root replacement (for those not requiring valve replacement)
Patient Experience
Patients can expect significant pain and fatigue immediately post-procedure, managed with medications. Discomfort decreases as recovery progresses. Emotional support and physical therapy may also be part of post-op care.