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BENTALL AND MINI BENTALL PROCEDURE PART.., 2.., CARDIOPULMONARY BYPASS, After systemic heparinization to an activated, clotting time of atleast 450 sec, peripheral venous, cannulation is performed., The venous cannula is connected to, cardiopulmonary bypass machine and arterial, cannulation is performed femorally or through the, distal ascending aorta., In most cases central aortic cannulation is, preferred approach to reduce risk of Retrograde, Embolism., For aortic root replacement, core body, temperature is cooled to 32 degree Centigrade., In cases where hemi arch replacement is necessary,, cooling to 25 degree centigrade is advised., Hemi arch replacement also requires configuration, of the arterial inflow line to provide Selective

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cerebral perfusion while the distal open, anastomosis is performed., AORTIC ROOT EXPOSURE, While cooling the bypass, flow is reduced and the, distal ascending aorta is cross clamped., Cold blood or custodial cardioplegia can be, delivered in an antegrade fashion through the, aortic root cannula or via direct coronary ostial, cannulation where aortic incompetence exists., Aortotomy is performed and the diseased, ascending aorta is resected, sparing a 1 cm cuff of, aorta proximal to the cross clamp., The aortic root and valve are inspected and the, aneurysmal aorta is resected leaving 1 cm of aortic, tissue above the annulus., The coronaries are then separated from the aortic, root as buttons,ideally allowing at least 3 mm of, tissue circumferentially around the coronary ostia., A pledgeted 2-0 ethibond traction suture is placed, just above each commissure.

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The commissural traction suture are then hitched, to the edges of the adjacent skin so that the root is, brought anteriorly and superiorly to expose the, aortic leaflets., Resection of the aortic leaflets is performed., Calcified annulus should be debridged., To avoid any particles falling into the left ventricle,, a ribbon gauze may be inserted into the ventricles, to catch any fragments during decalcification., , Thanks… To be continued…