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.
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.
By preserving the patient's own aortic valve, while replacing the aorta that surrounds it, the patient can avoid follow up surgery due to artificial valves. In addition, patients who keep their own valves won't need blood-thinning medication.
While patients make the final decision as to whether to undergo the aortic valve-sparing procedure, there are substantial benefits such as freedom from a regimen of blood-thinning medication. Many patients may benefit from this procedure, particularly the following groups:
Young patients
Taking blood thinners for life has different implications for 25-year-old patients than 85-year-old patients.
Frail patients
Patients at risk for bone fractures shouldn't take blood-thinning medication.
Active patients
Patients who enjoy activities where there is an elevated risk of injury might opt for valve sparing surgery. After surgery, patients can resume their fully active lives and discontinue taking blood thinners.
Women Planning to Become Pregnant
Blood thinning medication causes birth defects.
Montefiore Einstein Center for Heart and Vascular Care is part of the national clinical trial that is following the long-term benefits to patients who receive aortic valve-sparing surgery. Just as other studies led our surgeons to preserve a patient's original valve, this landmark trial will lead our surgeons to further technical innovations. By assuming a national leadership role, the Heart and Vascular Center ensures that its surgeons will be among the first in the nation to implement life-saving innovation.