A condition affecting the aortic root, ascending aorta, and/or aortic arch is operated on by a cardiac surgeon. During heart surgery, the diseased section of the aorta is replaced with a synthetic prosthesis.
© smart.servier.com
Surgery for an aortic aneurysm
A thoracic aortic aneurysm surgery involves surgically removing the enlarged section and replacing it with a synthetic vascular prosthesis. This prosthesis is made of polyester and comes in various sizes and shapes. The section of the aorta that needs to be replaced depends on the condition of the aortic valve, as well as the location and extent of the aneurysm.
Treatment of an aortic root aneurysm combined with aortic valve disease
If both the aortic root (the section of the aorta just above the valve) is dilated and the aortic valve is damaged, both are treated simultaneously. The type of surgery you receive depends on the exact location of the aneurysm and the nature of the valve problem.
- Valve-sparing aortic root replacement
This procedure is used when the aortic valve still opens and closes properly (no narrowing), but the aortic root is enlarged. The aneurysm is replaced with a vascular prosthesis, while your own aortic valve is preserved and reinforced. As a result, you do not need to take blood thinners for life.
2. Bentall procedure
A Bentall procedure is performed when the aortic valve can no longer be preserved due to severe damage or abnormalities. In this operation, the aortic root, ascending aorta, and aortic valve are completely replaced. The cardiac surgeon uses a composite prosthesis consisting of a valve prosthesis (biological or mechanical) attached to a synthetic vascular graft.
3. Ross procedure
During a Ross procedure, the diseased aortic valve is removed and replaced with your own pulmonary valve (the valve between the right ventricle and the pulmonary artery). This operation is mainly performed in younger patients. The pulmonary valve is then replaced by a homograft—a donor valve treated in a laboratory for use as a prosthetic valve. During the same operation, the aortic root can be replaced with a prosthesis that fits well with the new aortic valve. This renews and strengthens both the valve and the adjacent part of the aorta.
Replacement of the aortic arch
When the aortic aneurysm is located in the aortic arch, the arch is partially or completely replaced with a synthetic prosthesis. If the aneurysm extends over multiple parts of the aorta—for example, into both the aortic arch and further into the chest or abdominal cavity—the FET technique is applied. During the operation, the aortic arch is replaced with a synthetic prosthesis. Attached to this prosthesis is an integrated stent (a small tube reinforced with metal) that is inserted further into the descending aorta.
This combination—a prosthesis and a stent—supports both the arch and the deeper part of the aorta. Because the stent extends into the aorta like a trunk, this technique is also called the “Frozen Elephant Trunk” (FET). The FET enables simultaneous or stepwise treatment of multiple sections of the aorta, depending on the extent of the aneurysm.
© artivion.com
Personalized external support of the aortic root
The PEARS technique (Personalized External Aortic Root Support) is an innovative treatment for patients whose aortic root is mildly enlarged but not yet seriously damaged. Based on a CT scan, a personalized, flexible mesh is created that fits exactly around your aortic root. During the operation, this “sleeve” is placed around the aorta without opening the aortic wall or valve.
The support prevents further enlargement or rupture of the aortic root, while preserving your own aortic valve. Since there is no cutting into the aorta and the heart usually does not need to be stopped, this is a less invasive procedure compared to a traditional aortic root replacement.
© London Bridge Hospital
Procedure of the surgery
Aortic surgery typically lasts between 4 to 6 hours and is performed under general anesthesia. The risk, duration, approach, and course of the procedure may vary depending on the nature of the aortic condition, underlying medical issues (e.g., hereditary disorders), and the urgency of the operation.
- To access the aorta, the surgeon partially or fully opens the sternum. This procedure is called a (mini-)sternotomy. In some cases, the surgery is performed through a thoracotomy (between the ribs).
- A heart-lung machine temporarily takes over the function of the heart and lungs, allowing the heart to be stopped so that work can be done on the aorta (and possibly the aortic valve).
- In aortic arch surgery, additional measures are necessary to protect the brain and body from oxygen deprivation, including cooling the body.
- A synthetic prosthesis is sutured onto a healthy section of the aorta.
- Afterward, the heart-lung machine is stopped, and your heart resumes beating.