Figure 1.

The Bentall procedure. A–C, Schematic representations of the most commonly practiced variation of the Bentall procedure. The native wall of the aneurysmatic (A) or dissected ascending aorta is excised together with the stenotic or insufficient aortic valve (interposition technique). The ostia of the coronary arteries are cut out with a button of the native aortic wall attached (button technique) (B, arrow heads). The aorta and the aortic valve are substituted by one or multiple grafts (B, AoG) and a prosthetic aortic valve which are sutured to the LVOT (C, arrows) and the native aorta (C, curved arrows). The buttons around the coronary ostia are reattached to the aortic graft (C, arrow heads). D1–D2, 3D reconstructions of CTA images of a patient who underwent a Bentall procedure with the implantation of a mechanical aortic valve, performed according to the technique described above, showing the exterior surface of the aortic prosthesis and native aorta (D1) and the prosthetic aortic valve within (D2), respectively. D1, Ring of the aortic valve (arrows); AoG; anastomosis of the coronary arteries (arrow heads); distal suture line with the native aorta (curved arrows). D2, Metallic ring of the aortic valve (arrows); leaflet of the mechanical valve (arrow heads). Ao, native aorta; AoG, aortic grafts; LM, left main; LV, left ventricle; LVOT, left ventricleoutflow tract; RCA, rightcoronary artery.