Endo-Bentall-Current data on safety and efficacy

The ascending aorta and aortic root remain challenging areas for endovascular repair. While open surgical repair or replacement remains the gold standard, a proportion of the patients with ascending and/or root pathology are inoperable or at prohibitive surgical risk. Repair using conventional tubular ascending endografts is limited by anatomical constraints, especially inadequate proximal landing zones near the sinotubular junction (STJ), further complicated by the proximity of the coronary ostia. Therefore, endovascular strategies that enable anchoring in the aortic root may be required. To address these limitations, valve-carrying conduit concepts such as Endo-Bentall and Endo-Wheat have been proposed. These configurations integrate a transcatheter aortic valve with an ascending endograft, enabling coronary perfusion through fenestrations, branches, or uncovered segments. Early clinical experience is limited to a few published case reports to date, with heterogeneous techniques and no standardized procedural strategy. Although early technical success and short-term safety appear acceptable, conclusions are constrained by small sample size, selection bias, and limited follow-up. Proof-of-concept investigations, including ex vivo and in vivo animal studies, biomechanical modeling, and bench-top experiments using patient-specific three-dimensional (3D) anatomical models have been reported. These studies suggest stable deployment with preserved coronary perfusion; however, they do not establish clinical efficacy or safety in patients. At present, this approach should be considered an evolving strategy reserved for carefully selected patients with life-threatening aortic pathology where conventional surgery is not an option, pending robust evidence of safety, efficacy, and durability.