Needing surgery to repair an aortic root aneurysm is a scary diagnosis, but it doesn’t have to be. The methods for fixing this type of bulge in the aorta just above the aortic valve are durable and safe, when performed by experienced surgeons. With modern techniques, you’ll be back in your normal routine in no time.
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“We do virtually all aortic valve repairs/replacements and many aortic root procedures minimally invasively for a quicker recovery and less scarring,” says Lars G. Svensson, MD, PhD, Chairman of Cleveland Clinic’s Sydell and Arnold Miller Family Heart & Vascular Institute.
Big pipe, big problem
The aorta is the largest blood vessel in the body. It exits the heart at the aortic root, where the aortic valve is located as well as the opening to the coronary arteries. Here, it can be 1 to 1.5 inches in diameter.
When an aneurysm, or bulge, occurs in the wall of the aorta at the aortic root, the aorta widens, causing the aortic valve to leak blood back into the heart. With less blood pumped out of the heart into the aorta and less blood going into the coronary arteries, over time, the patient may feel symptoms of shortness of breath, fatigue or chest pain with exertion.
In some patients, particularly those with connective tissue disorders, or Marfan syndrome, aortic root aneurysm can eventually dilate greatly or dissect (tear). Loss of blood can be catastrophic, and survival is unlikely. For this reason, a dilated aortic root aneurysm may be replaced once the aneurysm reaches a certain size, usually more than 5.0 cm to 5.5 cm.
Different strokes for different folks
Cleveland Clinic surgeons have among the largest experience in the world with aortic root repairs and have some of the best results. Recently, they reviewed nearly 1,000 of four types of procedures they performed between 1995 and 2011 and found the surgery caused very few strokes. No patient whose aortic valve was preserved during one of the four procedures died in the hospital.
Of the four types of aortic root procedures, in three of them, the damaged aorta is replaced with Dacron tubing. The aortic valve may be retained as is, repaired, or replaced with a mechanical valve or a cow valve. For the fourth procedure, both the aorta and valve are replaced with tissue from a human cadaver.
The review found each procedure has its strengths and weaknesses that make certain procedures better for certain types of aneurysms, valve conditions and patients. As a result, Dr. Svensson and his colleagues recommend:
- Valve preservation and reimplantation for patients with healthy, normal, three leaflet aortic valves
- Valve preservation by remodeling for patients with healthy bicuspid aortic valves, usually by repairing the valves
- Using a Dacron graft with a mechanical valve in young patients with a stiff, hard, calcified aortic valve
- Using a Dacron graft with a cow valve for elderly patients with a stiff, hard, calcified aortic valve
- Replacing the aorta and aortic valve with cadaver tissue in patients with a bacterial valve infection (endocarditis), and perhaps for elderly patients with small aortic valves
Patients with connective tissue diseases such as Marfan syndrome are prone to aortic aneurysms. Dr. Svensson modified the popular David Reimplantation Procedure for use on patients with Marfan syndrome. His procedure spares the patient’s own valve to avoid the need for long-term blood-thinners and reduces the risk of stroke and endocarditis. As of April, 2015, 507 of these procedures have been done at Cleveland Clinic.
“With the exception of patients with endocarditis, we continue to advocate valve preservation, whenever feasible” says Dr. Svensson.