Mini Bentall operation: technical considerations

  • Marco Di Eusanio
  • Mariano Cefarelli
  • Carlo Zingaro
  • Filippo Capestro
  • Sacha Marco Luciano Matteucci
  • Alessandro D’alfonso
  • Michele Danilo Pierri
  • Marco Luigi Aiello
  • Paolo BerrettaEmail author
Review Article


Bentall operation via median sternotomy has been largely shown to be safe and long-term efficacious and currently represents the “gold standard” intervention in patients presenting with aortic valve and root disease. However, over the last years, minimally invasive techniques have gained wider clinical application in cardiac surgery. In particular, minimally invasive aortic valve replacement through ministernotomy has shown excellent outcomes and becomes the first choice approach in numerous experienced centers. Based on these favorable results, ministernotomy approach has also been proposed for complex cardiac procedures such as aortic root replacement and arch surgery. Herein, we present our technique for minimally invasive Bentall operation using a ministernotomy approach.


Aortic root surgery Minimally invasive techniques Bentall operation 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax. 1968;23:338–9.CrossRefGoogle Scholar
  2. 2.
    Berretta P, Di Marco L, Pacini D, et al. Reoperations versus primary operation on the aortic root: a propensity score analysis. Eur J Cardiothorac Surg. 2016:ezw250.Google Scholar
  3. 3.
    Gleason TG, David TE, Coselli JS, Hammon JW Jr, Bavaria JE. St. Jude Medical Toronto biologic aortic root prosthesis: early FDA phase II IDE study results. Ann Thorac Surg. 2004;78:786–93.CrossRefGoogle Scholar
  4. 4.
    Sioris T, David TE, Ivanov J, Armstrong S, Feindel CM. Clinical outcomes after separate and composite replacement of the aortic valve and ascending aorta. J Thorac Cardiovasc Surg. 2004;128:260–5.CrossRefGoogle Scholar
  5. 5.
    Zehr KJ, Orszulak TA, Mullany CJ, Matloobi A, Daly RC, Dearani JA, et al. Surgery for aneurysms of the aortic root: a 30-year experience. Circulation. 2004;110:1364–71.CrossRefGoogle Scholar
  6. 6.
    Nguyen TC, Terwelp MD, Thourani VH, Zhao Y, Ganim N, Hoffmann C, et al. Clinical trends in surgical, minimally invasive and transcatheter aortic valve replacement†. Eur J Cardiothorac Surg. 2017;51:1086–92.CrossRefGoogle Scholar
  7. 7.
    Totaro P, Carlini S, Pozzi M, Pagani F, Zattera G, D’Armini AM, et al. Minimally invasive approach for complex cardiac surgery procedures. Ann Thorac Surg. 2009;88:462–6.CrossRefGoogle Scholar
  8. 8.
    Tabata M, Khalpey Z, Aranki SF, Couper GS, Cohn LH, Shekar PS. Minimal access surgery of ascending and proximal arch of the aorta: a 9-year experience. Ann Thorac Surg. 2007;84:67–72.CrossRefGoogle Scholar
  9. 9.
    Hillebrand J, Alshakaki M, Martens S, Scherer M. Minimally invasive aortic root replacement with valved conduits through partial upper sternotomy. Thorac Cardiovasc Surg. 2017;
  10. 10.
    Shrestha M, Krueger H, Umminger J, Koigeldiyev N, Beckmann E, Haverich A, et al. Minimally invasive valve sparing aortic root replacement (David procedure) is safe. Ann Cardiothorac Surg. 2015;4:148–53.Google Scholar
  11. 11.
    Goebel N, Bonte D, Salehi-Gilani S, Nagib R, Ursulescu A, Franke UFW. Minimally invasive access aortic arch surgery. Innovations (Phila). 2017;12:351–5.CrossRefGoogle Scholar
  12. 12.
    Deschka H, Erler S, Machner M, el-Ayoubi L, Alken A, Wimmer-Greinecker G. Surgery of the ascending aorta, root remodelling and aortic arch surgery with circulatory arrest through partial upper sternotomy: results of 50 consecutive cases. Eur J Cardiothorac Surg. 2013;43:580–4.CrossRefGoogle Scholar
  13. 13.
    Benedetto U, Raja SG, Amrani M, et al. The impact of arterial cannulation strategy on operative outcomes in aortic surgery: evidence from a comprehensive meta-analysis of comparative studies on 4476 patients. J Thorac Cardiovasc Surg. 2014;148:2936–43.CrossRefGoogle Scholar
  14. 14.
    Di Eusanio M, Murana G, Cefarelli M, Mazzola A, Di Bartolomeo R. The Bentall procedure with a biological valved conduit: substitute options and techniques. Multimed Man Cardiothorac Surg. 2014;2014Google Scholar
  15. 15.
    De Paulis R, De Matteis GM, Nardi P, Scaffa R, Colella DF, Chiarello L. A new aortic Dacron conduit for surgical treatment of aortic root pathology. Ital Heart J. 2000;1:457–63.Google Scholar
  16. 16.
    Copeland JG, Rosado LJ, Snyder SL. New technique for improving hemostasis in aortic root replacement with composite graft. Ann Thorac Surg. 1993;55:1027–9.CrossRefGoogle Scholar
  17. 17.
    Rousou JA. Use of fibrin sealants in cardiovascular surgery: a systematic review. J Card Surg. 2013;28:238–47.CrossRefGoogle Scholar
  18. 18.
    Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2873–926.CrossRefGoogle Scholar
  19. 19.
    Roselli EE. Interventions on the aortic valve and proximal thoracic aorta through a minimally invasive approach. Ann Cardiothorac Surg. 2015;4:81–4.Google Scholar
  20. 20.
    Wachter K, Franke UF, Yadav R, et al. Feasibility and clinical outcome after minimally invasive valve-sparing aortic root replacement. Interact Cardiovasc Thorac Surg. 2017;24:377–83.Google Scholar

Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2018

Authors and Affiliations

  • Marco Di Eusanio
    • 1
  • Mariano Cefarelli
    • 1
  • Carlo Zingaro
    • 1
  • Filippo Capestro
    • 1
  • Sacha Marco Luciano Matteucci
    • 1
  • Alessandro D’alfonso
    • 1
  • Michele Danilo Pierri
    • 1
  • Marco Luigi Aiello
    • 1
  • Paolo Berretta
    • 1
    Email author
  1. 1.Cardiac Surgery Unit, Cardiovascular Department, Ospedali RiunitiPolitechnic University of MarcheAnconaItaly

Personalised recommendations