TREATMENT: COMPOSITE ROOT REPLACEMENT

The Aortic Root is made up of the first portion of the ascending aorta (called the sinus of valsalva) and the aortic valve. When the Aortic Root is enlarged,  Composite Root Replacement is often indicated. This involves replacing the sinus of valsalva and the aortic valve.

CompositeRootReplacement1

Intraoperative photograph of completed Mechanical Composite Root Replacement, Ascending aortic and hemiarch replacement.

 

 

 

 The operation is done through a midline incision. The ascending aorta is opened above the level of the aneurysm. The arteries that supply the blood to the heart are detached from the aneurysm. The aneurysmal tissue and the valve is removed.  A composite graft is sewn in place. The coronary arteries are sewn back to the new graft and the distal aspect of the graft is connected to the aorta where it is of normal size.

VSRR cartoon

Illustration depicting aortic root and ascending aortic aneurysm.   Completed repair with Dacron graft.  Note the coronary arteries have been reattached to the  Dacron graft.

 

 

 

The operation can be done with either a mechanical or tissue valve. In general , a mechanical valve tends not to break down and thus lasts a long time. However, a mechanical valve requires lifelong anticoagulation with an oral blood thinning medication called warfarin or Coumadin.  A tissue valve is usually made of cow tissue. The advantage of a tissue valve is that it does not require blood thinners. However, a tissue valve does not last as long as a mechanical valve.

CompositeRootReplacement3

Photograph of Compostive Valved Conduit with mechanical valve.