Giant Aortic Root Aneurysm Treated With Bentall Procedure: Technical Pearls and Intraoperative Strategies

Giant aortic root aneurysms are rare and potentially life-threatening, especially when the diameter exceeds 10 cm. These cases require urgent surgical intervention and pose significant technical challenges due to the risk of rupture, distorted anatomy, and associated valve dysfunction. We report the case of a 58-year-old man who presented with acute chest pain and refractory hypertension. Transthoracic echocardiography revealed severe aortic regurgitation, a dilated left ventricle with an ejection fraction below 30%, and an aortic root estimated at over 11 cm. CT angiography confirmed a giant aortic root aneurysm without dissection. Given the imminent risk of rupture, the patient underwent emergent open surgical repair. Axillary artery cannulation and early heparinization were performed to minimize intraoperative risk. Heparin was administered after axillary artery cannulation and before sternotomy to enable immediate initiation of cardiopulmonary bypass in case of rupture. A standard Bentall procedure using a 27 mm mechanical valved conduit and 30 mm Valsalva graft was successfully completed. The postoperative course was uneventful, and follow-up at three and nine months showed excellent clinical recovery and graft function. This case underlines the importance of early recognition and timely surgical intervention in giant aortic root aneurysms. Although the Bentall procedure is routinely performed worldwide, the surgical management of giant aneurysms >10 cm remains technically complex and underreported. Preoperative planning, alternative cannulation strategies, and meticulous surgical technique are crucial for safe and effective management of these high-risk cases.