Aortic aneurysms in the section of the aorta that connects to the heart are treated with a procedure called as aortic root replacement surgery. An aneurysm is a weak area in the wall of a blood vessel. Aneurysms have the potential to dissect (tear) or rupture, resulting in fatal internal bleeding. Marfan syndrome, an inherited disorder, may be the cause of aortic aneurysms close to the aortic root. Additional causes may encompass congenital heart conditions like a bicuspid aortic valve. By preventing rupture or dissection, aneurysm surgery can save a life.
The surgical approach can vary depending on several factors, including the condition of the aortic valve. It may entail either replacing both the valve and the aortic root or replacing the aortic root while preserving your valve (known as valve-sparing root replacement).
Aortic root replacement surgery is categorized into two main types: aortic root replacement (ARR) and valve-sparing root replacement (VSRR). Each of these approaches offers distinct advantages and carries its own set of associated risks.
Both types demonstrate outstanding long-term outcomes and pose a minimal risk of complications related to the valve. Based on the patient’s medical history and age, the surgeon decides what kind of treatment to perform.
The main advantage of VSRR is that patients are spared a lifetime of using blood thinners. They might have lower risk to experience a stroke or endocarditis. As long as the valve continues to function properly, the patient can maintain it for many years.
Aortic root replacement may be required in individuals with aneurysms that are susceptible to rupture or dissection. Age-related alterations to the aorta can occasionally lead to an aortic root aneurysm. Aortic aneurysms can also be brought on by genetic conditions like Marfan syndrome and Loeys-Dietz syndrome. In younger people, such diseases can cause deadly aneurysms
Aneurysm rupture or dissection is a possibility for those with Marfan syndrome who do not undergo treatment. In this group, the typical mortality age is 32; nevertheless, life expectancy is significantly increased after aneurysm repair surgery. 60% to 80% of these fatalities are due to aortic root problems. Even with smaller aneurysms, if other family members have Marfan syndrome, they may be at increased risk. The optimal time to start therapy and your own unique risk should be discussed with the healthcare provider.
The size of the aneurysm and other aortic dissection risk factors are used to develop aortic root replacement guidelines. When the patient’s aortic root aneurysm reaches one of the following diameters, surgery may be necessary:
Each person has a different medical background and specific requirements. As a result, the timing can vary depending on the patient’s age, general health, and risk of surgical complications. Smoking and uncontrolled hypertension are two factors that can fasten the growth of an aneurysm. Discuss the personal risks with the healthcare provider to determine the best time for the operation.
Aortic root replacement is a major surgical procedure. Similar to any major surgery, it involves potential risks and complications. Among them are the following:
People with additional major medical conditions, such as heart disease, kidney failure, lung illness, and a history of stroke, are more at risk for any open surgery.
The risk depends on the individual. With aging, risks also rise. Discuss the various dangers and how to manage them with the healthcare provider.
A successful surgery depends on preparation. The healthcare provider will perform a physical examination, and the patient will also visit the dentist for a check-up. The following pre-operative exams could be performed by the healthcare provider:
The patient should also engage in a discussion with their healthcare provider regarding:
The healthcare provider will provide the patient with comprehensive pre-procedure instructions, which should be followed closely. Typical recommendations may involve:
If the patient has any questions, be sure to ask the healthcare provider.
The patient will be made comfortable by the medical team, who will also provide anaesthetic to put them to sleep. They’ll be placed on a heart-lung machine (cardiopulmonary bypass). During surgery, this heart-lung machine performs the duties of the heart and lungs. The medical team may also stop the blood circulation via deep hypothermic circulatory arrest (DHCA). Throughout the procedure, these devices aid in controlling the blood flow.
Multiple steps are involved in aortic root replacement:
For ARR, the procedure takes four to five hours. For VSRR, the procedure takes four to six hours.
The patient will stay in the intensive care unit (ICU) for a couple of days following surgery. After that, they will transfer to a standard hospital room. About a week will be spent in the hospital.
During their stay in the hospital, the patient will get:
Take things slowly and pay attention to the advice of the healthcare provider. The healing period is essential for helping them get back to normal.
Make sure to arrange for a ride from the hospital to their home. You should refrain from driving until your healthcare provider gives you the green light to do so.
Recovery after an aortic root replacement procedure typically requires a minimum of six to twelve weeks, although some individuals may take two to three months to fully recuperate. This recovery period encompasses time spent in cardiac rehabilitation, at home, and in the hospital. It’s important to note that Medicare and most insurance providers offer coverage for up to 12 weeks of cardiac rehabilitation, making it a valuable investment in one’s recovery journey. Engaging in cardiac rehabilitation after heart surgery not only improves strength and quality of life but also provides an opportunity for patients to connect with others who have undergone similar experiences.
In order for the healthcare provider to assess the patient’s heart health after recovery, the patient will have routine follow-ups. Echocardiograms (echos) and CT scans will be part of their routine imaging. The aorta’s functionality is checked as a result of these tests.
The patient will be informed by the surgeon when it is okay to resume their regular activities. They should generally refrain from driving or lifting heavy goods for six weeks. After six to eight weeks, the patient might be able to go back to work, but only if their position doesn’t require much physical labor. They will have to wait longer for occupations that require physical exertion.
For the majority of patients, both surgical procedures—ARR and VSSR—are successful. According to research, 86% to 90% of patients do not require additional surgery 10 years after having their aortic roots surgery. Individuals with Marfan syndrome face an elevated likelihood of needing a subsequent surgical procedure.
In the majority of hospitals around the world, ARR is now a standard procedure. VSRR, notably the David method, is less common. This is due to the fact that VSRR is extremely complex and demands specific training and expertise. Excellent long-term outcomes and low rates of valve-related problems are associated with VSRR procedures.
As the patient recovers, pay attention to their body and how they are feeling. If any of the following issues arise, contact the healthcare provider immediately:
These issues could indicate a surgical complication. The healthcare provider will guarantee the patient receives the care and consideration they require.
+66 2066 8888