Valve-Preserving Aortic Root Replacement

About This Procedure

The aortic root is the first part of the aorta, 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. Aortic root aneurysm is an abnormal enlargement of the aortic root. 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. Aneurysmal dilation of the aortic root can lead to aortic regurgitation (or leaky aortic valve) that can result in development of heart failure. The presence of an aortic aneurysm also increases the risk of a sudden aortic catastrophe such as an aortic dissection (tear in the aortic wall), bleeding or rupture and sometimes death. Aortic root aneurysm repair is recommended to treat symptoms of heart failure and to prevent acute aortic complications.

During repair of aortic root aneurysms, the abnormal aortic root is replaced with an artificial graft. If the aortic valve leaflets (the flaps of tissue that hang from the wall of the aortic root and close in the middle of the tube to prevent blood from leaking backward) are still structurally normal, Massachusetts General Hospital cardiac surgeons can save the patient’s own valve. In this scenario, the valve is re-attached to the inside of the artificial graft that is used to replace the aneurysmal aortic root. Additional valve repair maneuvers can be performed to address the leaflet abnormalities and correct the aortic regurgitation. Preserving patient’s own valve can reduce the risk of prosthetic valve infection and help avoid the need for long-term blood thinners that would be necessary for some artificial valves.

If valve preservation is not possible, a composite aortic root replacement can be performed.

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.