When the aorta is dilated, but the aortic valve is structurally otherwise normal, the aorta can be replaced ("root replacement") while preserving the aortic valve ("valve sparing"). This avoids the need for a valve replacement with an artificial valve.  Thus offering the possibility for a more durable repair, as well as avoiding the potential need for blood thinning medication.

This approach also known as the David Procedure is a significant advance in aortic surgery. It is a highly advanced technique that requires special expertise and equipment. It should only be performed by experienced centers on well-selected patients.
Valve Sparing Aortic Root Procedure
  • Prior to the procedure, our surgical team, along with our cardiovascular imaging experts, carefully assess the valve and aorta to determine if the patient is a candidate for this specialized procedure.

Severe aortic insufficiency of echocardiogram
  • In the operating room, the patient is temporarily supported by cardiopulmonary bypass (aka a heart-lung machine), which takes over the function of the heart and lungs.  This is standard for heart and aortic surgery.  
  • After sowing a graft to the axiallary artery, the bloodflow is temporary stopped to the heart and the beginning portion of the aorta (aka the aortic root) to allow for the surgery to be performed. In addition, at our center, a special technique of circulating blood to the brain known as antegrade cerebral perfusion (ACP) is used to ensure the brain is protected during crucial portion of the operation
 
Axillary Cannulation for use in antegrade cerebrel perfusion
  • Next the diseased aortic tissue is removed
  • Leaving behind only the origins of the coronary arteries  and aortic value leaflets. 
Valve sparing aortic root aka David procedure - Excision of diseased aortic tissue
  • The aorta is replaced with a special collagen-coated, polyester graft. Then the graft is secured with sutures where the graft and heart meet.  

Collagen-coated, polyester graft for replacing the aorta
  • The aortic valve is then remodeled within the graft to eliminate leaking. This requires meticulous attention to ensure that the valve, based on its unique height and width, fits perfectly within the graft and any structural abnormalities of the valve are repaired. This ensures that the valve function properly, and the repair is durable. 
  • Then two small holes are created in the graft for reattachment of the coronary arteries--left and right.
  • Finally, the opposite end of the graft is attached to the aortic arch.

         Programs

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