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Endo-Bentall Repair for Inoperable Aortic Disease: Balancing Innovation and Ethical Responsibility
Geoffrey Ying1,2, Niklas Juth3, Anders Wanhainen1,4
1Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
EJVES Vascular Forum
|July 24, 2026
Summary
Introducing the novel Endo-Bentall procedure ethically requires careful patient selection and enhanced safeguards. Compassionate care guidelines support its use in select cases with clear communication about risks and outcomes.
Area of Science:
- Cardiovascular Surgery
- Medical Ethics
- Health Policy
Background:
- The Endo-Bentall procedure is a novel, high-risk intervention.
- Its introduction into clinical practice raises significant ethical considerations, particularly within compassionate care frameworks.
Purpose of the Study:
- To evaluate the ethical implications of implementing the Endo-Bentall procedure.
- To develop practical recommendations for its integration into clinical practice.
Main Methods:
- A seven-step ethical framework was applied to three clinical vignettes.
- Ethical issues were synthesized to inform practical recommendations.
Main Results:
- Decision-making for the Endo-Bentall procedure is complex due to limited outcome data and patient heterogeneity.
- Ethical justification is possible in selected cases where benefits outweigh risks, especially with limited alternatives.
Conclusions:
- Ethical implementation is feasible for select patients requiring the Endo-Bentall procedure.
- Essential safeguards include enhanced informed consent, conflict of interest mitigation, formal oversight, and integration into a learning health system.
