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. When the aortic valve is not calcified, the patient may be a candidate for a Valve Sparing Root Replacement (VSRR).
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 is removed. With a VSRR often leaflet repair is required to ensure that the valve leaflets will work correctly, opening and closing freely. The patient’s valve is preserved and re-implanted in the graft used to replace the dilated Root. 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.
Left: Intraoperative photograph of repaired valve resuspended in Dacron graft.
Right: Illustration of root and ascending aortic aneurysm treated with Valve Sparing Root Replacement and ascending aortic replacement.
VSRR is a newer surgical technique. By preserving the patient’s own aortic valve, patients avoid the need for lifelong anticoagulation therapy (coumadin). VSRR is generally indicated in younger patients who have Aortic Root dilatation and a leaky valve.
This link will take you to a video of the valve sparing root replacement http://www.annalscts.com/article/view/1410/2038.