Aortic root surgery

Aortic root surgery is a treatment for an enlarged section of the aorta, also called an aortic aneurysm. The aorta is the large blood vessel that carries blood from the heart to the body. The aortic root is where the aorta and the heart connect.

Aortic aneurysms near the aortic root may be due to an inherited condition called Marfan syndrome. Other causes include heart conditions present at birth, such as an irregular valve between the heart and aorta.

An aortic aneurism creates the risk of life-threatening events. As the size of the aorta increases, the risk of cardiac events increases. Aortic root surgery is usually done to prevent these conditions:

• A rupture of the aorta.
• A tear between the layers of the aorta's wall, called an aortic dissection.
• Backflow of blood into the heart, called aortic regurgitation, because of incomplete valve closure.

Aortic root surgery also is used as a treatment for aortic dissection or other life-threatening damage to the aorta.

The risks of aortic root surgery are generally high compared with other nonemergency surgery. Risks include:

• Bleeding that needs additional surgery.
• Aortic regurgitation.
• Death.

The risks are higher when aortic root surgery is done as an emergency treatment for aortic dissection or aortic rupture.

Aortic root surgery is done when the likely preventive benefits outweigh the risks of surgery.

Tests are done to determine your risk of aortic dissection or aortic rupture. Important factors include:

• Size of the aortic root.
• Rate of increase in size.
• Condition of the valve between the heart and aorta.
• General health of the heart.

The results of these tests are used to decide whether you should have surgery, when you have it and what type of surgery should be done.

There are several types of aortic root surgery, including:

• Aortic valve and root replacement. This procedure also is called composite aortic root replacement. A surgeon removes part of the aorta and the aortic valve. Then, the surgeon replaces the section of the aorta with an artificial tube, called a graft. The aortic valve is replaced with a mechanical or biological valve. Anyone who has a mechanical valve needs to take a blood-thinning medicine for life to prevent blood clots. Blood-thinning medicines also are called blood thinners or anticoagulants.
• Valve-sparing aortic root repair. A surgeon replaces the enlarged section of the aorta with a graft. The aortic valve stays in place. In one technique, the surgeon sews the valve inside the graft.

If you have another heart condition, your surgeon may treat it at the same time as aortic root surgery.

Aortic root surgery can prolong the life of people with aortic aneurysms. In hospitals with experienced surgical teams, the survival rate five years after surgery is around 90%. Survival rates are lower for people who have the surgery after an aortic dissection or aortic rupture or who need a repeat surgery.