Surgical Question: Why Replace Ascending Aorta And Root?

[skeptic49]

I posed a question to my cardiac care team at Temple University Hospital asking why it will be necessary to replace my entire aortic root and ascending aorta. My cardiologist, Dr. Martin Keane responded with this comprehensive explanation:

You have a bicuspid aortic valve (“congenital anomaly” - most common one - present in about 2% of human population). It turns out that not only does having a bicuspid aortic valve result in early valve disease (stenosis, regurgitation or both), but it is also associated with an abnormal weakness of the most proximal portions of the aortic “root” and ascending aorta. It’s known as “bicuspid aortopathy”. It is a form of annuloaortic ectasia, and any dilatation of the proximal aorta is usually associated with sinotubular effacement (that’s just a descriptor, not a pathology). After much population-based research, it has been determined that an aortic root or proximal ascending aortic diameter of ≥4.5 cm portends elevated risk of further dilatation and aneurysm formation over the long term. Thus, it is recommended that in bicuspid aortic valve patients whose aortas are larger than that, the proximal aortic root be replaced as well. It’s more of a gray zone below 4.5, but I’ve cared for patients who’d had smaller aortas at the time of bicuspid aortic valve replacement, and then a few years later, needed to go BACK to the OR for replacement of an ascending aortic aneurysm. That is clearly a sub-optimal situation. With you proximal ascending aortic measurement of 4.6 on your recent CTA, it is most prudent to replace both the valve, root and proximal-most portion of the ascending aorta."​

What he is saying is that my cat scan shows a dilated ascending aorta at 46mm, and my aortic root, where the aorta meets the heart, is also dilated. So the surgical plan is to replace my diseased aortic valve attached to a dacron graft to replace my aorta starting at the heart all the way up to the beginning of the aortic arch. The procedure is known as the Bentall Procedure. The coronary arteries are detached from the diseased aorta and re-attached to the dacron graft. When they remove the coronary arteries from the aorta they leave a ring of aortic tissue around the opening of the coronary artery. This "button" makes it easier for the surgeon to sew the coronary arteries into the graft. The procedure is called a "Button Bentall."

 

[RobThatsMe]

Good info.... while preparing for my 2nd OHS, (due to scar tissue preventing my original mechanical valve from functioning after 10 yrs),
my doctor put it to me in simple terms, " I don't think that you would want to be back here for another surgery in 3 to 5 years"
So for my 2nd OHS they did Bentall, and also a stint with an additional 20 cm of Dacron tubing attached to it, descending down the aorta to help support my dissection.

 

[river-wear]

Cool info, Jim. Thanks for sharing.

Good luck with your surgery!

 

[pellicle]

Skeptic, that's great info, I assume that is what they did to me too (no one told me that level of details)

Did you type that all in from a voice recording or cite a reference? Hats off if you typed that all in

 

[skeptic49]

Skeptic, that's great info, I assume that is what they did to me too (no one told me that level of details)

Did you type that all in from a voice recording or cite a reference? Hats off if you typed that all in

I cut and pasted it from an email...I get that level of detail because like you I do my homework and requested it. This is why I have supreme confidence in this team at Temple...my cardio, my surgeon and his team. They are responsive and get right back to me with answers in great detail. It also helps me to know that my surgeon specializes in the treatment of aneurysms. My surgeon has a web site http://www.badaorta.com