Modified Bentall Procedure With Internal Tunneling Coronary Artery Transplantation

Background: The Bentall procedure remains a golden standard of the aortic root surgery particularly in aortic aneurysm and ascending aortic dissection,since decades many modifications are been done to improve the outcome of the surgery.We present in our study the outcome of particular modified technique using bovine pericardium in internal tunneling coronary artery transplantation.Methods: From 2015 March-2018 August,26 patients(n=26)with a mean age of 52.7±10.07 years went under this procedure using a bovine pericardium for internal tunneling coronary artery transplantation.That helps to reduce the tension between the coronary ostium and the artificial graft and also minimize the pseudoaneurysm after surgery.All the patients were selected based on a special criterion i.e.the distance between the coronary ostium and aortic annulus is less than 2cms.We also made some technical modifications in sewing the bovine pericardium that acts as a bib between the Dacron graft and the ostium.This technique also reduced the cross-clamp time and perfusion time.Results: One patients i.e.3.8% in the group did not make it after surgery because of the myocardial failure and renal insufficiency in one patient(3.8%)and multiple organ failure in an aortic dissection patient.Low cardiac output is seen in one patient(3.8%),neurological stroke is seen in one aortic dissection patient which make hi to stay in ICU longer than other patients.Remaining 25 patients i.e.96.2% discharged with no complications and most of them have a regular follow-up for at least 3 times in one year.Conclusion: the modified Bentall technique with internal tunneling coronary artery transplantation with an extremely low incidence of anastomic complications particularly at the coronary ostium.Along with wrapping the ascending aorta and making a shunt to the right atrium reduced the risk of post operative bleeding.