The ascending aortic artery is the portion of the aorta running between the aortic arch and the heart. The aortic valve is an exit in the heart between the ascending aorta and the left ventricle. In a healthy heart, the leaflets (or flaps) of the aortic valve meet to create a seal that helps keep blood flowing in the correct direction. When the aorta dilates near the aortic valve, it pulls that valve apart. This prevents a tight seal and allows the valve to leak.

Until recently, when surgeons removed an aneurysm or diseased section of the ascending aorta, they also removed the aortic valve and replaced it with either a mechanical valve (made from carbon and metal) or a valve from a cow, pig, or human. Although the replacement valve is necessary for the patient's health, blood often sticks to artificial valves. To combat this, patients with mechanical replacement valves must take blood-thinning medications for the rest of their lives. This is a significant side effect for patients whose valves were not diseased.

How is aortic valve-sparing surgery performed?

With aortic valve sparing surgery, surgeons no longer cut out normal valves when replacing diseased sections of the aorta. Instead, surgeons save the valve and coronary arteries by detaching them from the area of the aorta being replaced.

Next, the graft replacing the removed section of aorta is sewn to the heart, with the aortic valve suspended within the graft. The surgeon then sews the left and right coronary arteries to the graft. Finally, the graft is connected to the rest of the patient's aorta. At the end of the procedure, the patient's aortic valve has been preserved despite the replacement of the aorta that feeds into it.

How does aortic valve-sparing surgery benefit patients?

By preserving the patients own aortic valve while replacing the aorta that surrounds it, patients can avoid the need for follow-up surgery necessitated by artificial valves. And, patients who keep their own valves don't need to take blood-thinning medication.

While the final decision about whether to submit to the aortic valve-sparing procedure is up to patients, freedom from a regimen of blood thinning medication has substantial benefits to many patients, particularly the following groups:

Young patients
Taking blood thinners for life is a substantially different commitment for 25-year-old patients than 85-year-old patients.

Frail patients
Patients at risk for breaking bones shouldn't take medication to thin their blood.

Active patients
Rock climbing and blood thinning medication don't mix. Patients who enjoy activities where there is an elevated risk of injury might opt for valve sparing surgery so that they can opt out of blood thinners and resume their fully active lives.

Women planning to become pregnant
Blood thinning medication causes birth defects.

Spearheading innovation

Montefiore-Einstein is part of the national clinical trial following the long-term benefits to patients who receive aortic valve-sparing surgery. Just as innovation helped surgeons today understand the wisdom of preserving a patient's original valve, information collected during this landmark trial will help surgeons of tomorrow further refine their techniques. By assuming a national leadership role, Montefiore-Einstein ensures that its surgeons will be among the first in the nation to implement life-saving innovation.

© 2010 Montefiore Medical Center