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Aortic Root

Baylor Scott & White Medical Center - Templo

Extensive experience treating aortic root disease and evaluating best outcomes

Baylor Scott & White Medical Center – Temple has extensive experience treating aortic root disease, including high-complexity procedures and valve-sparing root surgery. Our program is a referral center for Central Texas, and we have a multi-disciplinary team that evaluates complex patients and builds consensus for the best outcomes.

The Baylor Scott & White Medical Center – Temple building at night

Signs of an aortic root aneurysm

The aortic root is the part of the aorta closest to the heart and includes the aortic valve and the origins of the coronary arteries.

The aortic root can develop an aneurysm (bulge), causing the aorta to widen, which sometimes can lead to the aortic valve becoming regurgitant or leaky. Other times the valve remains competent with an aortic root aneurysm.

Aortic regurgitation symptoms

Because of aortic regurgitation, there is less blood reaching the aorta and the rest of the body, including the coronary arteries. Patients with an aortic root aneurysm may feel shortness of breath, fatigue or chest pain with exertion.

Aortic root aneurysm diagnosis

Evaluation for aortic root aneurysm can include a CT angiogram, an MRI and an echocardiogram. Prior to elective surgery, a cardiac catheterization is performed to determine the coronary artery anatomy.

A medical illustration showing Sinus of Valsalva and Sinotubular Junction

Treating the aortic root

Aortic root aneurysm treatment here in Temple includes blood pressure control using diuretics, antihypertensives and beta-blocking medication.

Surgery is recommended once the aortic root aneurysm reaches a size of 5.0 cm to 5.5 cm or continues to expand at a rapid rate (0.5 cm per year). If a patient has a genetically mediated disorder (Marfan syndrome, Ehlers-Danlos syndrome, bicuspid aortic valve, etc.), aortic root aneurysm surgery is offered at smaller diameters (4.0 cm – 5.0 cm).

Heart patients undergoing aortic valve surgery for stenosis or regurgitation who are found to have an aortic root greater than 4.5 cm are also considered for an aortic root replacement.

A medical illustration of the aortic root showing the cusps and annulus
Aortic root surgery options
Aortic valve and root replacement
Aortic valve and root replacement (composite aortic root replacement) involves removing the aortic root, including the aortic valve. The aortic root can be replaced with a tube graft containing either a tissue valve or a mechanical valve, and the coronary arteries are reattached to the tube graft. Another conduit used, especially if infection is a concern, is an aortic root conduit from a human donor (homograft).
Valve-sparing aortic root repair
In patients with an aortic root aneurysm associated with a competent aortic valve, valve-sparing aortic root repair is the treatment of choice, where the aortic root is replaced while preserving the aortic valve. A tube graft is sewn in, and then the native valve is sewn to the inside of the graft (David procedure). The valve function is tested using multiple modalities including an echocardiogram before completion of the surgery.

Possible complications of aortic root surgery

 
 

Risks for aortic root surgery include:

  • Bleeding and possibly needing blood product transfusion
  • Infección
  • Renal failure
  • Injury to the heart’s conduction system and possibly needing a pacemaker
  • Limiting blood flow to the heart by kinking of the coronary arteries
  • Carrera
  • Death

What to expect with an aortic root surgery

After an evaluation by the heart team at Baylor Scott & White – Temple and undergoing appropriate testing, you will meet our nurse educator who will give you a booklet and talk to you about the stepwise progression you will be expected to make through your heart surgery. Your medications will be discussed, and you may be asked to stop certain medications up to one week before the procedure. It is important to plan ahead and make arrangements for transportation to and from the hospital and also help at home after the procedure.

After arriving at the admitting area, heart patients are seen by the operating room team, including the anesthesia team who start an intravenous line to give medications. The family will be asked to stay in the waiting area until the aortic root surgery is complete. Patients are placed on a ventilator for the duration of the surgery and a few hours after surgery. The aortic root surgery can last several hours depending on the complexity and on the findings in the operating room. After completion of the surgery, the heart surgeon will speak to the family about the procedure and answer any questions, including expected aortic surgery recovery time.

Aortic root surgery patients are usually in the hospital for five to seven days. The stay in the ICU is usually for the first 24 hours, followed by a transfer to a monitored bed on the floor. Most patients begin walking the day after surgery. We have a large team of people here in Temple who specialize in the various aspects of recovery to work with you, teach you and instruct you on the best practices for your recovery. Follow-up visits in the clinic are at two weeks and four weeks after aortic root surgery.

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