Лучшие больницы для «Bentall Procedure» в Дели (NCR), Индия

The aortic root — the segment of the aorta that originates directly from the left ventricle and houses the coronary ostia and the aortic valve annulus — is uniquely vulnerable to aneurysmal dilation, dissection, and valvular dysfunction. When the aortic root diameter exceeds 5.0–5.5 cm (or 4.5 cm in patients with Marfan syndrome, Loeys-Dietz syndrome, or bicuspid aortic valve disease), the risk of acute aortic dissection or rupture increases exponentially, carrying a mortality rate of 1–2% per hour without emergency surgery. Concomitant aortic valve pathology — stenosis, regurgitation, or endocarditis-related destruction — may render isolated valve replacement insufficient if the structural integrity of the root itself is compromised.

• ELIGIBILITY — Aortic root aneurysm with root diameter ≥ 5.5 cm in non-syndromic patients (CT angiography or MRI confirmed)
• ELIGIBILITY — Aortic root diameter ≥ 4.5–5.0 cm in patients with Marfan syndrome, Loeys-Dietz syndrome, Ehlers-Danlos syndrome (vascular type), or bicuspid aortic valve with associated connective tissue disorder
• ELIGIBILITY — Acute or chronic Type A aortic dissection involving the aortic root, requiring emergency or urgent root replacement
• ELIGIBILITY — Severe aortic valve disease (aortic stenosis with mean gradient > 40 mmHg or aortic regurgitation with LVESD > 50 mm) in the presence of root dilation ≥ 4.5 cm, making isolated valve replacement insufficient
• ELIGIBILITY — Aortic root endocarditis with annular abscess or pseudoaneurysm formation, where valve-sparing or isolated repair is not anatomically feasible
• +13 more

STANDARD BENTALL PROCEDURE (COMPOSITE VALVE GRAFT — MECHANICAL): The classical and most widely performed approach uses a composite graft pre-sewn or hand-sewn with a bileaflet mechanical valve (most commonly On-X or St. Jude Medical Masters Series). The coronary arteries are detached from the native root as 'buttons' of aortic wall tissue and reimplanted directly into pre-cut holes in the Dacron graft — the 'button Bentall' technique, which has supplanted the original inclusion (wrap) technique due to lower risk of late pseudoaneurysm formation. This approach requires lifelong anticoagulation with warfarin (target INR 2.5–3.5). It is preferred for younger patients (< 60 years) who have no anticoagulation contraindications and desire durability without reoperation risk.

BIOPROSTHETIC COMPOSITE GRAFT (TISSUE VALVE BENTALL): For patients over 65 years, women of childbearing age, those with occupational bleeding risk, or patients who decline lifelong anticoagulation, a bioprosthetic tissue valve (Carpentier-Edwards PERIMOUNT Magna Ease, INSPIRIS RESILIA with anti-calcification polymer treatment, or Medtronic Mosaic) is incorporated into the composite graft. The INSPIRIS RESILIA valve features VFit technology, enabling future transcatheter valve-in-valve (TAVR-in-surgical-valve) implantation if structural valve deterioration occurs — a major strategic advantage that eliminates the need for high-risk redo open surgery in elderly patients.

VALVE-SPARING ROOT REPLACEMENT (DAVID PROCEDURE — ALTERNATIVE): For patients under 50 with a structurally normal, pliable aortic valve (tri-leaflet, leaflet height > 17 mm, no commissural fusion) who wish to avoid prosthetic valve and anticoagulation altogether, the David reimplantation procedure (David V technique) is offered at GAF Healthcare partner centers. The native aortic valve is preserved and resuspended within a Dacron tube graft, restoring aortic root geometry. Freedom from reoperation at 10 years exceeds 90% in experienced hands. This is not a Bentall Procedure per se but is the direct alternative and is evaluated case-by-case.

MINIMALLY INVASIVE / MINISTERNOTOMY APPROACH: Selected centers in India and the UAE now offer the Bentall Procedure through an upper (partial) ministernotomy (J-sternotomy or upper mini-sternotomy), limiting the incision to the upper third of the sternum. This approach reduces wound complications, blood loss, ICU stay, and postoperative pain while preserving the mechanical advantages of full sternotomy access. Patient selection requires preoperative CT planning to confirm root accessibility. Not suitable for redo sternotomy cases or those requiring concomitant mitral or tricuspid surgery.

PRE-ARRIVAL PHASE (2–4 weeks before travel):

• GAF Healthcare case manager reviews CT angiography, echo reports, and surgical history to match patient with appropriate surgeon and hospital
• Telemedicine consultation with operating cardiothoracic surgeon to discuss valve choice (mechanical vs. tissue), operative risk (EuroSCORE II / STS PROM), and expected outcomes
• e-Medical Visa application facilitated by GAF Healthcare (India) or tourist/entry visa guidance (UAE — UAE nationals and many GCC passport holders enter visa-free or on visa-on-arrival)
• Travel insurance with cardiac surgical cover obtained; anticoagulation instructions issued if patient is on warfarin or antiplatelet therapy
• Preadmission blood work, ECG, and pulmonary function testing arranged locally or on arrival

DAY 1–2 (admission & Preoperative WORKUP):