Aortic root surgery is a treatment for an enlarged aorta, also known as an aortic aneurysm. The aorta is the large blood vessel that carries blood from your heart to the rest of your body. The aortic root is just near the junction between your aorta and your heart, and contains the aortic valve and the coronary arteries. 

You may have an aortic aneurysm and not really be aware because it may not be causing you too much pain, but if it bursts (ruptures) or tears (aortic dissection), this will cause you pain and be dangerous. Aortic root surgery is a procedure which aims to prevent ruptures and tears. 

Aneurysm assessment

Before making any decisions, we look at the size of the aneurysm and consider whether it's likely to burst, or not. If the aortic root is too large (about 5.5cm in diameter), then surgery is very likely. 

Surgery

The best option is to try and preserve the existing valve. Doing this means that you won't have to take anticoagulation drugs like warfarin for the rest of your life, and evidence shows that it reduces the risk of valve-related complications in the future. 

One way of preserving the valve is by surgically restoring the shape of the root, a method pioneered by former Harefield surgeon, Sir Magdi Yacoub. Doing this improves the performance of the aortic valve. Another way to preserve the valve is to re-implant it. By putting the valve inside a tube, we can make the aortic root the right size and make the valve function properly again. 

Replacing the aortic valve

In some circumstances, preserving the valve isn't possible so we replace it with either a mechanical valve or a valve made of pig, cow or human tissue. 

If you have a mechanical valve replacement, you will have to take the anticoagulant drug warfarin for the rest of your life, which is not ideal for young patients. Tissue valves are an alternative but because of the limited lifespan of such valves, you would need another operation in the future. 

Conditions which weaken the aortic wall

If you have a condition which may weaken the aortic wall, you may have to wait until your aneurysm is smaller before being allowed surgery. These conditions include:

  • bicuspid aortic valve 
  • Marfan syndrome
  • Ioeys-Dietz syndrome
  • Ehlers-Danlos syndrome

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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