Aortic Root Repair or Replacement

The aorta is the large blood vessel that carries blood from the heart to the rest of the body. The aortic root is the section of the aorta closest to and attached to the heart. An aneurysm is an abnormal bulge in the wall of an artery. If the aneurysm develops in the aortic root, the aorta can dilate and the aortic valve can leak (regurgitation). If the aneurysm continues to expand, it can rupture. The layers of the aortic wall can also separate (aortic dissection). This can cause life-threatening internal bleeding.

Aortic root surgery is a procedure performed to prevent or treat an aortic aneurysm. This procedure can be performed using the following methods: Non-Invasive, or through open-heart surgery. The type of method chosen will vary according to your particular health condition.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.

Types of Aortic Root Repair/Replacement

• Valve-Sparing Aortic Root Replacement (David or Yacoub): A procedure that repairs aortic root aneurysms while preserving the patient’s own aortic valve. Preservation of the patient’s existing valve avoids the need for long-term use of blood-thinning medications and increases the long-term durability of the valve.
• Composite Aortic Root Replacement (Modified Bentall): A type of procedure performed to repair the aortic root and replace the damaged aortic valve with a prosthetic or synthetic valve.
• Homograft Valve/Root Replacement: For those complex cases (e.g. endocarditis or multiple previous root surgeries), this procedure may use a tissue graft from a donated human heart.

How to Prepare for the Procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Diabetes and how to adjust your medicine on the day of the procedure.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any implanted device (e.g. pacemaker or ICD).
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before the Procedure

Before the procedure, your doctor may perform a variety of diagnostic tests, including:

• Cardiac Catheterization
• Computed tomography (CT scan)
• Magnetic Resonance Imaging (MRI)
• Echocardiogram (ECHO)

What to Expect During the Procedure

Aortic root surgery usually takes 4 to 6 hours, but the preparation and recovery may add several hours. This procedure is usually performed in the cardiothoracic operating room (OR). Check with your doctor about the details of your procedure. In general, during a Modified Bentall procedure:

• You will change into a hospital gown.
• A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
• Prior to starting the procedure, you will receive a local anesthetic. Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
• Your doctor will administer general anesthesia (will make you feel sleepy).
• The procedure begins when your doctor exposes your heart by dividing the breastbone (sternum) in half. Your doctor then spreads both halves to gain access to your heart (open-heart surgery).
• For this type of surgery, your heart must be still. Prior to doing so, your doctor will place tubes into your heart so that blood can be pumped through your body by use of a heart-lung machine. This machine takes over for the heart by replacing the heart’s pumping action and the lungs by adding oxygen to the blood
• Once the blood has been diverted into the bypass machine for pumping, your doctor will then stop the heart by injecting it with a cold solution.
• When the heart has been stopped, your doctor will repair the aortic root and replace the aortic valve with a prosthetic or synthetic valve.
• After this process is complete, the doctor will closely check as blood runs through this new valve to make sure it’s working properly. Once checked, the doctor will let the blood circulating through the bypass machine back into your heart.
• If your heart is not restarting after the procedure is complete, a mild electric shock may be used to restart it.
• Your doctor may also put temporary wires for pacing into your heart. These wires can be attached to a pacemaker, if needed, during the initial recovery period.
• Once the procedure is complete, the heart-lung machine will be turned off. The tubes will be removed and the sternum will be sewn together with the use of sutures or surgical staples.

What to Expect After the Procedure

After the procedure, you will be taken to the cardiothoracic intensive care unit (CTICU) for further observation for several days. This type of procedure usually requires a hospital stay of several days or even longer. Other recommendations include:

• The breathing tube is removed when you wake up from anesthesia.
• Diet is started the day after surgery with liquids, and quickly advanced to solids as tolerated.
• Ambulation is started on the first or second day of surgery.
• Urine catheters and drainage tubes (chest tubes) are removed after 24 to 48 hours.
• If you have pacing wires, your doctor will remove those too.
• Nurses, respiratory therapists, and physical therapists will work with you as you begin physical therapy and breathing exercises.
• Your doctor will give you instructions to follow during your recovery.
• A cardiac rehabilitation program may also be suggested.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.