Aortic root replacement surgery

What is an aortic root replacement?

The aorta is the largest blood vessel in the body and carries blood from the left side of the heart to the organs of the body.

An aortic aneurysm develops when the wall of the aorta weakens causing it to bulge. The reasons why the aorta weakens are not fully understood. It may be associated with atherosclerosis (fatty deposition / cholesterol build up in the lining of the arteries), high blood pressure, and connective tissue disorders including Marfan’s syndrome or being born with an abnormal aortic valve (bicuspid aortic valve). If the aneurysm is inside the chest it is called a thoracic aortic aneurysm.

The ascending aorta can be replaced with an artificial tube graft. If the ascending aorta has to be replaced immediately above the aortic valve, the aortic valve may also have to be replaced and the coronary arteries re-implanted into the side of the tube graft: this is known as an aortic root replacement.

What are the symptoms of a thoracic aortic aneurysm?

Many patients with aneurysms of the ascending aorta and aortic root may have no symptoms.

However, thoracic aortic aneurysms may cause:

• Breathlessness
• Chest pain
• Back pain
• Coughing
• Wheezing
• Hoarseness or difficulty swallowing.

If the aneurysm ruptures it will cause severe internal bleeding. This may be fatal without emergency surgery to repair it.

What are the risks of not undergoing surgery to repair a thoracic aortic aneurysm?

Without surgery an aneurysm may rupture. The chance of an aneurysm rupturing depends on its size and rate of growth. If the thoracic aneurysm is greater than 5.5cm in diameter there is a significant chance of rupture. Aortic aneurysms can also be associated with heart failure and aortic dissection, which is a life-threatening condition resulting in the lining of the aorta being torn.

If you have a thoracic aortic aneurysm which is less than 5 cm in diameter you should be enrolled into a surveillance programme. If you have an aortic aneurysm which is 5 cm or greater you may require surgery.

What are the benefits of surgery?

The surgery reduces the risk of sudden death due to rupture.

Complications can be prevented by replacement of the ascending aorta / aortic root with an artificial tube graft. Sometimes this also requires replacement of the aortic valve and re-implantation of the coronary arteries (aortic root replacement). When performed electively this is a low risk procedure.

Surgical intervention may improve any symptoms relating to aortic aneurysms including aortic dissection (where the lining of the wall of the aorta is torn).

What are the risks of surgery?

When performed electively this is a low risk procedure. All risks will be discussed with you by your consultant during the pre-operative consultation.

How long will it take to recover?

After the surgery, you will be transferred to the cardiac-intensive care unit and be kept under observation for 24 hours. You will be moved to the ward for the following seven to ten day, after which you will be able to go home.

The consultant will advise you when you can return to your normal activities. Many factors such as age, overall health, smoking, etc. can affect an individual’s recovery which is why the consultant will be able to best advise you.

It will take about six weeks until your sternum will be completely healed so do not lift heavy things during that period.