There are few diseases and condition which can lead to dilatation of Aorta i.e Aneurysm or tear in Aorta leading to Aortic dissection. These conditions can lead to life threatening complication or can be life threatening itself in form of Type A dissection thus leading to surgical intervention on priority or emergency as per the presentation of the patient.Common cause of the same may be
- Connective tissue disorder like Marfan syndrome
A variety of surgical procedures are done as per the presentation like Aortic valve with Ascending Aorta replacement (Bentall Procedure), aortic arch, descending Aorta, thoracoabdominal or Abdominal Aorta repair. Also we have option of endovascular repairs whenever feasible in our multidisciplinary team.
The Bentall procedure is a surgery performed to correct defects of the aorta. The procedure involves the replacement of the aortic root (base of the aorta) and valve (three flaps that ensure the one-way flow of blood from the heart to the aorta), and re-implantation of the coronary arteries (that branch out from the ascending aorta). The current and most common type of surgery is called the button Bentall surgery.
The Bentall surgery is indicated for the following conditions of the aorta:
- Aortic regurgitation or stenosis with enlargement of Aorta
- Marfan’s syndrome (genetic disease that causes aortic wall weakness)
- Aortic dissection (separation of the layers of the aortic wall)
- Aortic aneurysm (enlargement of the aorta)
Aortic root replacement with a composite valve-graft is a surgical treatment for aortic root aneurysms with a diseased aortic valve. It involves replacement of the root and aortic valve with a graft and either a biological or mechanical valve prosthesis. This procedure is performed under general anaesthesia, and with the heart temporarily stopped using cardiopulmonary bypass. First the aorta is cut and the diseased portion is removed, including the aortic valve. The coronary arteries (blood vessels that supply oxygen-rich blood to the heart muscle) are disconnected. A graft with a valve inside it is then sewn to the heart and to the other side of the aorta. Two small holes are made in the graft, and the coronary arteries are then re-connected through them.
Usually after the procedure patient remains in intensive care unit for 2-3 days , where he will be on moniter with few line and drainage tubes. After that he is shifted to wards where we keep him for 3-5 days as per recovery then discharge him once all parameters are satishfactory and anto coagulant levels have been achieved.
The aortic valve controls the unidirectional flow of blood from the heart to the entire body. Diseases that cause narrowing (aortic stenosis) and leaking (aortic regurgitation) of the aortic valve decreases the function of the left ventricle and cardiac output, and increases the risk for congestive cardiac failure and death. The Ross procedure is a technique used to treat the diseased aortic valve and prevent further damage to the heart. The procedure involves replacing the diseased aortic valve with your pulmonary valve, which controls the unidirectional flow of blood from the heart to the lungs for purification. This is also called a valve switching procedure as the patient’s own pulmonary valve is used to replace the diseased aortic valve.
The procedure is performed under the effect of general anaesthesia. During this open heart procedure, the heart’s function of pumping blood is taken over by a heart-lung machine. Your doctor introduces medication to temporarily stop your heart from beating. An electrocardiogram is used to continuously monitor your heart rate and rhythm throughout the procedure.
Your surgeon makes an incision in the middle of the chest and separates the breastbone to gain access to the heart. The pulmonary valve is excised. The damaged aortic valve is carefully removed and replaced with your own pulmonic valve. A pulmonary valve taken from a human donor is then placed into the pulmonic position. The heart is disconnected from the heart-lung machine and its function resumed. The breast bone is brought together and the chest incision is closed with sutures.
After the procedure, you are moved to the cardiovascular intensive care unit, and your heart rate, rhythm and vital signs are closely monitored. You may experience numbness, itching and tingling, which will subside after a few days. Your doctor will prescribe medication to relieve pain, reduce discomfort and improve mobility. Scars will fade within 3 to 6 months. You should include a balanced diet to promote healing and improve your strength after the surgery. Your physical therapist may suggest a home walking program and physical exercise to improve flexibility, circulation and muscle tone. Avoid lifting heavy objects, pulling or pushing for a few months after the surgery. Inform your doctor if you experience high fever, shortness of breath, irregular heartbeats, or swollen feet and ankles.
Risks and complications
As with any surgery, the Ross procedure may involve certain risks and complications. They include:
- Bleeding and infection
- Stroke, heart attack
- Breathing problems
- Irregular heartbeats or death
Advantages and disadvantages
The advantages of the Ross procedure include:
- Improved performance of the patients’ pulmonary valve in the aortic position
- Superior blood flow with reduced wear and tear of the heart
- Anti-coagulants not necessary
- Less chance for infection
The disadvantages of the Ross procedure include:
- Complex surgery
- Follow-ups required for both aortic and pulmonary valves