About the surgery

Aortic root replacement can be done in two ways, either by

• Valve-Sparing Aortic Root Replacement which involves keeping your own aortic valve, or

• Aortic Root and Aortic Valve Replacement (Bentall Procedure) where both the aorta and valve are replaced at the same time.   

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Valve-Sparing Aortic Root Replacement

The valve-sparing aortic root replacement is a surgical treatment for aortic root aneurysms. With this method, the aneurysm is repaired with a graft while the patient’s own aortic valve is preserved. This avoids having to use a prosthetic valve, thereby avoiding the risks involved with having a mechanical or biological (tissue) valve.

 

This procedure is technically difficult. It is performed under general anaesthesia while the heart is temporarily stopped using the heart-lung machine (cardiopulmonary bypass). First, the aorta is cut and the diseased portion is removed. The coronary arteries (blood vessels that supply oxygen-rich blood to the heart muscle) are disconnected. Then the patient’s aortic valve size and height are measured so that an appropriately sized graft can be made.

 

Sutures are placed below the aortic valve and through the end of the graft, which connects them together. The patient’s own aortic valve is then re-suspended within the graft and sewn into place. The valve is tested to make sure it opens and closes properly, and without any leakage.

 

Two small holes are made in the graft, and the coronary arteries are re-connected through them. The other end of the graft is then connected to the rest of the aorta. If part of the aortic arch also needs to be replaced, a separate graft is used.

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Bentall Procedure (Aortic root and valve replacement)

The Bentall Procedure is performed with a composite valve-graft (a synthetic tube which has an aortic valve included as part of the graft) and is a surgical treatment for aortic root aneurysms with a diseased aortic valve. It involves the replacement of the root and aortic valve with a graft and either a biological or mechanical valve prosthesis. Whether to choose a biological (tissue) or mechanical valve is complex, and every patient should discuss this with their surgeon. Mechanical valves are very durable, however, they require lifelong blood thinners (e.g. warfarin) which increase the risk of bleeding and need regular monitoring. Biological valves do not require blood thinners, but do not last as long as mechanical valves (on average 15-20 years) and may require another operation after this. Please see our page, "Mechanical or Tissue Valve?"

 

This procedure is performed under general anaesthesia, with the heart temporarily stopped using the heart-lung machine (cardiopulmonary bypass). First, the aorta is cut and the diseased portion is removed, including the aortic valve. The coronary arteries (blood vessels that supply oxygen-rich blood to the heart muscle) are disconnected. A graft with a valve inside it is then sewn to the heart and to the other side of the aorta. Two small holes are made in the graft, and the coronary arteries are then re-connected through them.

 

Recovery period

Patients usually stay in the intensive care unit for one to two days for monitoring and then move to the ward for four to five days. Two to three tubes stay in the chest to drain fluid from around the heart and are usually removed one to three days after the surgery. Full recovery usually takes about two months. Most patients are able to drive in about four to six weeks after surgery. Your surgeon will provide specific guidelines for your recovery and return to work.

 

Risks of the surgery

As with all surgery, aortic root replacement surgery is associated with some risks. Your surgeon will calculate these risks specific to you, and discuss them with you.

 

All patients should consult their cardiothoracic surgeon for specific information about their medical condition and surgery. 

 

For more information: 

Bentall Procedure St Vincent's Hospital