What is aortic root surgery? 

Aortic root surgery is a complex surgical procedure to treat a dilation or enlargement (aortic aneurysm) of a section of the large blood vessel that carries blood from your heart to your vital organs (aorta). The aortic root is located near the junction of your aorta and your heart. It contains the aortic valve and the coronary arteries.

Aortic root surgery is performed to prevent an aneurysm rupture or aortic dissection (tear in the inner layer of the wall of the dilated aorta) and to stop the dilated aorta from stretching the aortic valve. Aortic aneurysms near the aortic root may be associated with Marfan syndrome and other heart conditions.

The aortic root needs replacing if there is an aneurysm of the aorta. The diameter of the aneurysm is used to assess the risk of rupture or dissection (tear). If the aortic root is near or around 5.5cm in diameter then in most cases surgery is performed.

For patients with a condition that weakens the aortic wall, eg Marfan syndrome, loeys-Dietz syndrome, ehlers-Danlos syndrome and other genetically abnormal conditions, surgery will be needed when the aneurysm is even smaller in size.

The most common genetic abnormality is a bicuspid aortic valve. The trigger for surgery in this case is between 4.5 cm and 5.0 cm in diameter.

Historically, aortic root replacement includes substituting the aortic valve and the aorta. In younger patients, a replacement of the aortic valve with a mechanical prosthesis is durable but requires the individual to take warfarin for the rest of their lives. Alternatively, replacement with a tissue valve requires a repeat operation because of its limited life span.

Preserving the existing valve has the obvious advantage of reducing the need for anticoagulation drugs, e.g. warfarin, and there is increasing evidence that it minimises the risk of valve-related complications in the future. Remodeling of the root was originally designed by Professor Yacoub, and it has been shown to restore the shape of the root and improve the aortic valve performance.

A re-implanting technique has also been developed where the existing valve is re-implanted inside a vascular tube graft. It makes the aortic root the correct size and restores the valves function.

Marfan syndrome is a genetic disorder that affects the connective tissue in the body due to abnormalities in growth proteins.

Our team of surgeons, physicians and specialist radiologists work together to diagnose, screen and treat patients from childhood to extreme old age, who have an aortopathy (any disease of the aorta).

Some of these aortic diseases are directly related to abnormalities of the aortic valve. 

The Trust’s team includes: 

Cardiac surgery

Professor John Pepper, consultant cardiac surgeon and academic lead 
Mr Ulrich Rosendahl, consultant cardiac surgeon and clinical lead for the aortic service 
Mr Darryl Shore, consultant cardiac surgeon (ACHD)
Mr George Asimakopoulos, consultant cardiac surgeon 
Mr Jullien Gaer, consultant cardiac surgeon 
Mr Toufan Bahrami, consultant cardiac surgeon
Mr Sunil K. Bhudia, consultant cardiac surgeon
Mr Cesare Quarto, consultant cardiac surgeon

Vascular surgery

Professor Nick Cheshire
Mr Maziar Mireskandari

Cardiology

Professor Christoph Nienaber, cardiologist and interventional cardiovascular physician 
Dr Lorna Swan, consultant cardiologist
Dr Ali Vazir, consultant cardiologist

Imaging and radiology

Dr Michael Rubens, consultant radiologist (CT)
Dr Saeed Mirsadraee, consultant radiologist (CT)
Dr Simon Padley, consultant radiologist (CT)
Professor Raad Mohiaddin, consultant radiologist (CT)

Genetics

Dr Anand Saggar, clinical geneticist


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