Composite Aortic Root Replacement

About this Procedure

The aortic root is the first part of the aorta, which is the main blood vessel that carries blood from the heart to the entire body. The aortic valve and the coronary arteries, which supply blood to the heart itself, are attached within the aortic root. An aortic root aneurysm (an abnormal enlargement of the aortic root) increases the risk of a sudden aortic catastrophe such as an aortic dissection (tear in the aortic wall), bleeding or rupture and sometimes death. These aneurysms can be sporadic or can be associated with certain familial conditions such as Marfan’s syndrome, Loeys-Dietz syndrome, bicuspid aortic valves and other conditions. Aortic root aneurysm repair is recommended to prevent acute aortic complications.

Aortic root aneurysms can often be associated with an abnormality of the aortic valve, such as:

• Aortic stenosis (valve does not open properly)
• Aortic regurgitation (valve does not close properly).

Aortic stenosis can cause symptoms such as chest pain, light headedness and syncope (passing out), and both aortic stenosis or regurgitation can result in heart failure, which can cause fatigue, shortness of breath with activity, swelling of the legs and difficulty sleeping when lying flat.

Replacing the Aortic Root and Valve

Composite aortic root replacement involves replacing both the aneurysmal aortic root and the diseased aortic valve. The aorta is replaced with an artificial polyester graft and if the valve is unable to be spared (as in a valve-sparing aortic root replacement), then an artificial aortic valve is used to replace the diseased valve. The aortic valve can be replaced either with a bioprosthetic aortic valve made from cow or pig tissue, or a mechanical valve made from metal. The mechanical valves have the advantage of being very durable, but require life-long use of blood thinner medications to prevent blood clots on the valve. On the other hand, while the bioprosthetic valves do not require blood thinners, they may deteriorate over time and require a re-intervention. Massachusetts General Hospital cardiac surgeons discuss the risks and benefits of either approach with the patient and make a personalized decision based on patient’s age, health condition and preference.

Patient Referrals

Patient referrals can be made to the Thoracic Aortic Center at 617-724-4747 or directly to any of the participating physicians. Coverage is available 24 hours per day, seven days per week to receive emergency referrals from any regional physician or emergency department if an acute syndrome related to the thoracic aorta is suspected. A phone call to the Thoracic Aortic Center will set in motion the assembly of a team for emergency evaluation and management of the patient.

Outpatient referrals of patients with thoracic aortic aneurysms will result in multidisciplinary evaluation by appropriate physicians from cardiology, vascular radiology, cardiac and vascular surgery. Patients can be seen by multiple physicians on the same day, and the appointments are made with a single phone call to the Thoracic Aortic Center number.

Evaluation will result in a recommendation for either intervention or follow-up. Follow up for the aortic problem will be arranged at the Center. General cardiac and pulmonary evaluation may also be done.