Bental Procedure

A Bentall procedure is a surgery to help correct problems with your aorta. Your aorta’s role is to carry oxygen-rich blood from your heart to the rest of your body. Sized at around 30 centimeters long and 2.5 cm wide, your aorta is the largest artery in your body.

The Bentall procedure is a type of cardiac surgery involving composite graft replacement of the aortic valve, aortic root, and ascending aorta, with re-implantation of the coronary arteries into the graft. This operation is used to treat the combined disease of the aortic valve and ascending aorta, including lesions associated with Marfan syndrome. The Bentall procedure was first described in 1968 by Hugh Bentall and Antony De Boo.

Your doctor may recommend a Bentall procedure for you if you have problems with your aorta. Some of the most common issues that can occur include:

  • Aortic regurgitation – when your heart’s aortic valve doesn’t close properly
  • Marfan’s syndrome – a disease from birth that weakens the aortic wall thickness
  • Aortic aneurysm – widening of the aorta
  • Aortic dissection – when the inner layer of the aorta tears

As with any surgery, there are some risks associated with a Bentall procedure.

Common risks are those which more than 5% of patients may experience. These can include:

  • Bleeding
  • Abnormal heart rhythms, called arrhythmias– mostly temporary
  • Short term memory problems, blurred vision and difficulty concentrating – mostly temporary

Uncommon risks are those which less than 5% of patients may experience.

These can include:

  • Infection
  • Lung and kidney problems
  • Heart attack and stroke
  • A blood clot in lung or legs
  • Death

Your doctor will explain these risks in detail before you agree to the surgery - and you’re also encouraged to discuss any questions or concerns with your medical team.

Your surgery will take place in a hospital operating theatre. Your doctor will take you to the theatre on a trolley or wheelchair, and you’ll be asked to lie on a narrow table.

The Bentall procedure is performed under general anesthetic, which means you will be given medications before your surgery to relax and make you fall asleep.

After you fall asleep, your doctor will:

  • Remove the affected part of your aorta and aortic valves
  • Temporarily remove your coronary arteries
  • Insert an artificial aortic graft with a built-in valve
  • Make two holes in the graft and re-attach the coronary arteries

The entire procedure takes around five hours.

After your Bentall procedure, you’ll spend one or two days in an intensive care unit (ICU), where you’ll be connected to machines to monitor your heart, blood pressure, body temperature, and breathing.

Your wound may be sore, but you’ll be given medications to help with the pain. You will also have some tubes draining fluid from your chest.

On the first day after your surgery, you should be able to sit out of bed in a chair and take a few steps - but it’s important not to rush your recovery. You’ll need to ease back to your regular movements and take time to recover well.

When you’re ready to leave the ICU, you’ll go to the cardiac ward for another few days.

During your stay in the cardiac ward, you’ll need to be aware of:

  • Wound care – your nurse will help to make sure your wound is clean and healing well.
  • Bowel function – it is easy to become constipated after a big operation. It may be due to your tablets or because you are less active than usual. Drinking fluids and eating foods such as fruit, vegetables, and grains may help. There is also medication available to help, to discuss any concerns with your nurse
  • Stitches and wires – your medical team will let you know when any stitches and wires will need to be removed, and this will happen before you leave the hospital
  • Discomfort – you might feel tightness in your chest and shoulders, and changing your position frequently to maintain good posture can help. Use painkillers regularly so that you can move, take deep breaths, and sleep comfortably. Taking painkillers regularly will keep pain under control. You can learn more tips about managing chest discomfort here
  • Fever – some people find that they are sweaty, especially at night in the early days after surgery. Others may find it hard to keep warm. This will improve as your body gets back to normal after the operation. You may have a slight fever in the first few days after your operation which is entirely normal, and there is medication to help with this
  • Palpitations - you may feel extra heartbeats after surgery. This is due to the heart being sensitive after the operation. It usually settles down in the first four weeks after the procedure. If you experience palpitations, contact your doctor
  • Vivid dreams and sleeping problems - it may take a few weeks to get back to your regular sleeping pattern. In the early days, you may find that a brief day time nap may help. Try to follow your usual bedtime routine and take pain relief shortly before attempting to sleep. Avoid sleeping on your stomach for the first six weeks
  • Blurred vision - some people see dots or flashing lights in front of their eyes. This is due to the operation and will settle down with time. If you have your eyes tested or see your eye doctor, explain that you have had heart surgery
  • Reduced appetite and changes in taste - you may notice that you have a poor appetite and find that food has lost its flavour. Your sense of smell may change, and you may also experience a strange metallic taste in your mouth. This can be caused by the operation or your medication and can take three months to recover fully. Try to eat frequent small amounts of cold and straightforward foods - not spicy or rich in flavour.

Your medical team will help you with some of the physical aspects of your recovery, including:

  • Physiotherapy routine – you can start to work on your activity levels while still in the hospital
  • Mobility – it will take 6-8 weeks for your breastbone to heal, and your nurse will show you the safest ways to lift and move your body, including rolling and sitting in bed. You can learn about protecting your breastbone after cardiac surgery in our sternal precautions brochure.
  • Breathing exercises – you’ll be shown breathing exercises and coughing techniques that don’t harm your recovery

It’s completely normal to feel a range of different emotions during this time. You may have up and down days, strange dreams and changed sleeping habits - but none of this means your body is having trouble recovering. It’s essential to talk about your feelings with your family and friends so they can support you as you recover. Keeping a diary is the right way for you to understand your range of emotions.

When it’s time to leave the hospital, you’ll need to arrange for a family member or friend to collect you and take you home (please advise the nursing staff of whom you have arranged to pick you up and transport you home). For information, including guidelines and tips for traveling by car or plane after heart surgery, you can visit our travel page. Find someone whom you can rely on to help you at home during those first few weeks. If you need assistance with this, let your medical team know.

As you prepare to return to your normal way of life, you’ll be given detailed instructions for exercise, medications, ongoing wound care, and resuming normal activities. We also encourage you to book into a cardiac rehabilitation program. Doing this will help you to recover as best you can and live a healthy, fulfilling life.

Before you leave the hospital, you will be given contact details for your closest cardiac rehabilitation program. In your program, you’ll be supported every step of the way as you heal, recover, and get back to your normal, everyday life.

Remember to follow your doctor’s advice about medications and any recommended lifestyle changes after your surgery, and attend your regular appointments. If you start to feel unwell or would like to discuss your follow-up care at any time, make an appointment with your doctor.

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