Valve-Sparing Aortic Root Replacement
From the desk of Dr. Grayson Wheatley
"Preserving the Aortic Valve is the Future."
Nashville, Tennessee - Aortic aneurysms can arise in any portion of the aorta. The aorta - the main blood vessel of the body - connects to the heart at the level of the aortic valve, ascends in the chest towards the neck (ascending aorta), gives off branches to the brain (aortic arch), and curves around (like a candy cane) before running the length of the torso.
A lot of critical structures are located in the area where the aorta connects to the heart and aortic valve. Called, the aortic root, this anatomic region is one of the most complex areas of the body.
The aortic root comprises the first 2-4 cm (an inch or two) of aorta from its connection point at the aortic valve.up to the ascending aorta. Within this region are the sinuses of Valsava, which is the bowing-out of the aorta above each leaflet of the aortic valve. There are commonly 3 leaflets to the aortic valve and 3 associated sinuses of Valsalva.
The bowing-out, or bulging of the aorta in this region allows the aortic valve with open and close in a three-dimensional space and not be confined to a single, horizontal plane.
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Additionally, in this region, the main coronary arteries arise, separately providing all the blood flow to each side of the heart muscle (left and right).
Finally, there is a discrete anatomic transition from the aortic root to the ascending aorta, called the sinotubular junction, which represents a return to normal size of the aorta above the bulging sinuses.
Aortic aneurysms located in the aortic root, commonly seen in patients with Marfan Syndrome, can affect the function of the aortic valve as a result of stretching the attachment sites (aortic annulus) where the leaflets of the aortic valve insert. Essentially what happens is that even though the leaflets are essentially normal, they are "flapping in the breeze", so to speak, and the leaflets can't touch when the valve opens and closes with the heartbeat. This creates aortic insufficiency (leaky valve) which is detected as a heart murmur.
The traditional surgical technique for repairing the aortic root involves a Bentall procedure, which consists of cutting out the aortic valve and aortic root separately and replacing the aortic valve along with the aortic root using an aortic valve-conduit device. This device has an artificial heart valve incorporated into a synthetic, woven polyester tube (Dacron). To perform a Bentall procedure, open heart surgery is involved. Furthermore, the left and right main coronary arteries (which arise separately from the aortic root) need to be temporarily disconnected from the aorta and re-attached to the new aortic surgical graft as part of the Bentall procedure.
Newer intricate surgical techniques have been developed to enable surgeons to preserve the patient's own aortic valve (since the valve leaflets are essentially normal) and just replace the aortic root tissues along with re-implantation of both of the coronary arteries.
Not all patients are candidates for the valve-sparing aortic root replacement (VSRR) surgical option. The decision on who is a candidate for the valve-sparing option is a complex decision process based on a number of factors, such as patient age, quality of the aortic valve leaflets and function of the heart muscle.
The Aortic Center at Centennial Medical Center is pre-eminently qualified and skilled at treating patients with all forms of open aortic surgery and procedures (chest and abdomen) and is prepared to care for all patients with aortic aneurysms, aortic dissections and other types of aortic diseases including aortic transections, aortic pseudoaneurysms and penetrating aortic ulcers.
Contact us today to request your consultation at 1-615-342-6900 or email us firstname.lastname@example.org and we will evaluate your unique aortic problem and provide a customized approach to your specific aortic problem.
Centennial Medical Center
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Dr. Grayson Wheatley is a Heart and Vascular Surgeon and Director of Aortic and Endovascular Surgery at TriStar Centennial Medical Center in Nashville, TN
Aortic Root Aneurysm involving the left and right main coronary arteries and aortic valve.
Valve-sparing Root Replacement involving reimplantation of the native aortic valve into a prosthetic surgical graft to preserve the patient's own aortic valve tissue.