Staged Endo–Bentall Procedure for Acute Type A Aortic Dissection

All articles of this category (opens in new window) Background: The Endo–Bentall technique is still under development, and no dedicated devices exist. Reported experiences rely on modifications of devices originally designed for related but distinct purposes. We herein describe an emergency Endo–Bentall procedure in which a transcatheter heart valve (THV) was combined with a modified thoracic endograft carrying retrograde branches for the coronary arteries. Methods: An 85-year-old female patient with acute type A aortic dissection was referred to our center. Given two prior open heart surgeries (mitral and tricuspid valve repair in 2005, SAVR with 25 mm Mosaic in 2017) and a high comorbidity burden (EuroSCORE II 77.7%), open surgery was refused. A THV was sutured into a Zenith thoracic endograft. Two retrograde branches constructed from Viabahn stents were anastomosed to the left and right coronary neo-sinuses. Gold markers were added to guide alignment with the coronary anatomy. The delivery system was modified with a proximal release mechanism using diameter-reducing wires and by shortening the nose cone. During deployment, an offset between the coronary ostia and the graft branches prevented correct alignment. As a result, the two branches had to be switched, which simplified the final connection but transformed the procedure into an unplanned staged approach. On postoperative day 6, the left coronary branch was connected to the left coronary artery, and the distal landing zone was extended. On postoperative day 10, the right coronary artery was successfully connected, completing the Endo–Bentall. Results: The postoperative course included respiratory failure without invasive ventilation, pleural effusion requiring drainage, and urinary tract infection treated with antibiotics. The patient was discharged on postoperative day 30 with NYHA II dyspnea and preserved independent mobility. Echocardiography at discharge demonstrated preserved biventricular function and trace paravalvular leakage of the THV with a transvalvular pressure gradient of 13/7 mmHg. Conclusion: Endo–Bentall may represent a viable alternative to open surgery for acute type A aortic dissection in patients at prohibitive risk. The described procedure required innovative modifications of the delivery system and was completed in a staged fashion due to intraoperative difficulties with coronary alignment. The intervention was executed by an interdisciplinary team comprising vascular surgery, cardiac surgery, and interventional cardiology, with equal contribution—underscoring the central role of collaborative teamwork in pioneering approaches to complex aortic disease. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany