Title : Aortic root replacement
Abstract:
Aortic root replacement is an operation that requires resection of diseased aortic sinus tissue. Patients requiring aortic root replacement include those with combined aortic valve degeneration and aortic pathology, such as bicuspid aortic stenosis and root aneurysm. Other indications include aortic dissection involving the aortic root and valve, endocarditis with destruction of both leaflets and the aortic annulus, or congenitally small left ventricular outflow tract where root replacement can simultaneously enlarge the aortic root and allow for implantation of an adequately sized prosthesis.
Depending on the specific patient pathology, the operation typically entails removal of aortic sinus tissue, resection or preservation of the aortic valve leaflets, and reimplantation of the coronary arteries. While more complicated that standard aortic valve replacement, these operations address both leaflet and aortic root pathology at the same time. When performed at experienced centers, aortic root replacement is a safe and effective operation for patients with concomitant aortic valve pathology and aortic root disease.
Surgical options include stented and stentless bioprosthetic valved conduits, mechanical conduit, cryopreserved aortic homograft, pulmonary autograft, and valve-sparing root replacement. Each of these operations have unique features for reconstruction of the aortic root and particular advantages for specific patients. Proper prosthesis selection is necessary for each patient, particularly in the very young and very elderly populations. Outcomes after the various operations are generally good with durable long-term results. However, each prosthesis has associated potential long-term consequences requiring ongoing surveillance and management. Knowledge of the various options is essential to helping patients understand their potential options and care after surgery.
Audience Take Away:
- Attendees with learn relevant aortic root anatomy
- Review of indications for aortic root replacement
- Description of various operative techniques
- Discussion of outcomes after surgery for aortic root disease
