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The first case of minimally invasive Bentall surgery for ascending aortic aneurysm and severe aortic insufficiency in Northwest China

Updated: Sep 25, 2020
From: Department of Cardiovascular Surgery
Edited by: Liu Huiting

Recently, Department of Cardiovascular Surgery of the First Affiliated Hospital of Xi 'an Jiaotong University (XJTU) successfully performed the first case of "minimally invasive Bentall surgery" for a patient with ascending aortic aneurysm complicated with severe aortic insufficiency in Northwest China, which filled the gap of minimally invasive surgery for large vessels and opened a new chapter of minimally invasive cardiovascular surgery in this region.

The story from "I’m fine" to "transfer to ICU"

In early September 2020, Mr. Chen, aged 47 years old, suddenly developed chest pain and severe cough with a large quantity of white phlegm. His wife advised him to go to the hospital, but he rejected saying that "I’m fine, take it easy!" The symptom of chest pain was alleviated approximately 10 minutes later. On the night of September 12, when he was asleep, he suddenly felt unbearable chest pain and could not lie on his back, which lasted for 20 minutes. The next morning, he was immediately admitted to a local hospital for diagnosis and treatment. Echocardiography and CT scan showed the signs of "severe aortic insufficiency, mitral regurgitation, tricuspid regurgitation and enlargement of ascending aorta, which was suspected with aneurysm". Due to the complicated and critical condition, he was transferred to the First Affiliated Hospital of XJTU from Emergency Outpatient to cardiovascular surgical ICU at 19: 09 on September 15.

Full preoperative preparations and surgical expertise create the miracle of dismantling the bomb in heart

Before the surgery, the wife burst into tears and begged the doctors to save her husband. Motivated by the sincere trust, the cardiac surgery team carefully analyzed the condition of the patient and found that besides heart valve defects, the diameter of ascending aorta reached 7.1 cm, significantly larger than 3 cm in healthy population, which was like a bomb buried in the heart. If it is not dismantled in a timely manner, the patient might die from the rupture of the aneurysm. In addition, Mr. Chen had to work and recover as soon as possible to raise the family. After comprehensive consultation by the expert team, Director Yan decided to perform "minimally invasive Bentall surgery" to minimize surgical trauma and accelerate postoperative recovery.

Bentall surgery is a highly-demanding and complex cardiovascular procedure and one of the most efficacious treatment foraortic aneurysm, which consists of ascending aorta replacement+aortic valve replacement+coronary artery grafting. Conventional Bentall surgery is an open surgical procedure, which can cause severe trauma, excessive bleeding and long recovery time. Minimally invasive Bentall surgery can be performed by simply cutting a small incision of approximately 8-10cm between the second or third rib on the right chest wall, which causes milder trauma, less bleeding, slighter chest injury, less postoperative pain, lower incidence of postoperative complications and shorter recovery time. However, it is a highly complex surgery and has demanding requirement for the surgeons due to the small incision and insufficient exposure of surgical field.

At 19: 00 on September 18, Mr. Chen was transferred to Operation Room. With the cooperation of Zhou Heping, Zheng Xinglong, Li Jianpeng and other surgeons, Professor Yan Yang successfully dismantled the “bomb” in the patient’s heart. The operation lasted for less than 5 h with 100 ml of intraoperative blood loss and a surgical incision of merely 9 cm. After the operation, the patient was transferred tocardiovascular surgical ICU for monitoring and treatment. On September 20, he successfully weaned from the ventilator, and was able to move and eat in bed. On September 22, he was transferred to cardiac surgical ward for postoperative rehabilitation.

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