• Mehrdad Ghoreishi, Aakash Shah, Diljon Chahal, Jeanwan Kang, Anuj Gupta, Bradly S Taylor, and Shahab Toursavadkohi.
• Department of Surgery, Division of Cardiac Surgery, Miami Heart Vascular Institution, Miami, Florida. Electronic address: Mehrdad.ghoreishi@gmail.com.
• J. Thorac. Cardiovasc. Surg. 2025 Jan 15.

ObjectiveWe present our experience with endovascular Bentall procedure (Endo-Bentall) using a modular valve conduit (Endo-Bentall) in high-risk patients with aortic root pathologies.MethodsThe physician constructed Endo-Bentall device is composed of a self-expanding transcatheter aortic valve (TAVR), aortic endovascular stent graft (TEVAR), and two wire-reinforced fenestrations for coronary artery stenting. The TAVR valve is sutured into an appropriately sized TEVAR graft. The coronary fenestrations are made in the TEVAR graft based on CTA measurements. The Endo-Bentall device is then re-sheathed within the TEVAR delivery system, advanced via femoral access and is deployed during rapid pacing. If persistent endo-leak is present after device deployment, the coronary ostia are accessed and stented. No cardiopulmonary support is required.Results5 patients with prohibitive risk (mean age 79 years) underwent Endo-Bentall repair from November 2022 - October 2023 (Type A dissection N = 4, aortic root aneurysm N = 1). Severe aortic insufficiency was present in 2 patients preoperatively. The median back table modification time was 120 minutes (range 55- 150 minutes). The Endobentall device was successfully implanted in all patients (100%). Two patients required concomitant total endo-arch repair. In hospital mortality was 0%. No patient had postoperative stroke. Coronary stenting was required in 3 patients. One patient required permanent pacemaker insertion. On follow - up CT scan (median of 172 days (range: 63-368), no patient had a type 1a endoleak. No aortic insufficiency was present on follow up transthoracic echocardiography.ConclusionThe Endo-Bentall repair using a single-stage valve-carrying conduit is feasible and effective with encouraging early outcomes for highly selected patients with aortic root dissection or aneurysm who are deemed not to be operative candidates. Long-term follow up data are required to assess the persistence of the seal and ongoing durability of this novel technique.Copyright © 2025. Published by Elsevier Inc.

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