Introduction
The aorta is recognized as the vital blood vessel that is concerned with the distribution of oxygen-loaded blood to the entire body parts. It stems from the lower left heart chamber called the left ventricle. After stemming from there, the aorta traverses upward and then takes a turn to descend towards the abdomen. In the course, it branches out to nourish the cells in various body parts. The name aortic root explicitly denotes the point of the aorta that bridges with the heart, and it encompasses the aortic valve, which ensures that the blood flows only in the intended direction by checking the backward flow.
The aortic root possesses certain lumps from which the coronary blood vessel arises. Coronary blood vessels nourish the heart muscles that keep the heart functional. The segment of the aorta directed vertically upward is medically called ascending aorta. In contrast, the term arch of the aorta identifies the highest point of the C-shaped curve.
What Is Aortic Root Replacement?
Aortic root replacement (ARR) is a surgical intervention where the impaired aortic root portion is replaced, and the aortic blood flow is reinstated. It is a complex intervention that entails expert hands to work upon. The defective segment is removed, and the structural loss is restored with a graft's help to establish the function and structure of the aortic root. Bentall procedure is the alternate name for ARR.
In ARR, the aortic root portion encompassing the aortic valve that guards the entry of blood from the lower left chamber to the aorta will be surgically eliminated. It is an integrative surgical approach that works well for both the aortic valve and root problems. Artificially fabricated aortic valve and aortic root grafts are used to reconstruct the resected portion to restore the structural and functional deficit. It takes an average of four to five hours to complete ARR.
What Are the Medical Conditions for Which Aortic Root Replacement Is Indicated?
Aortic root replacement is a blessing for those patients who are detected with troubles involving both the aortic root and valve. Aortic aneurysm in the aortic root portion is the primary indication for the aortic root replacement. An aortic aneurysm is a medical condition where a particular segment of the aorta elicits bulging and appears to be dilated than the rest of the area. It develops in the weak points of the aorta due to the pressure exerted by the flowing blood. Those compromised aortic areas cannot bear the force of blood flow, and it splits and cleaves the layers that make up the aortic wall. This allows the blood to seep in between the layers, leading to ballooning at that particular point. This condition is medically called an aortic aneurysm. This aneurysm carries the risk of blood vessel breach or rupture, which can endanger one's life.
Aortic regurgitation is another condition that arises mainly due to impaired aortic valve function. The aortic valve is intended to block the reverse blood movement from the aorta back to the left ventricle, and it has three cusps that ensure patency in the blood flow. Abnormalities associated with the aortic valve, like the bicuspid valve (two cusps) and unicuspid valve (one cusps), can impair how a normal aortic cusps works. Such valves cannot seal off the connection between the left ventricle and the aorta effectively, which allows some blood to escape into the left lower chamber from the aorta. This condition is denoted as aortic regurgitation. The aortic valve may also develop calcifications (stenosis) in the long run, restricting the blood flow.
In such cases, the valve must also be replaced to establish the patency. Suppose a patient has aortic regurgitation, aortic stenosis, and an aortic aneurysm. In that case, the best choice of surgical intervention is aortic root replacement so that by a single surgical technique, both defects can be promptly rectified.
What Are the Procedures Involved in Aortic Root Replacement?
Before the procedure, patients will be subjected to various preparatory tests, including blood tests and other cardiac imaging tests. The patient will be given an appropriate anesthetic agent to keep them pain-free and sedated. The surgery will be performed with the assistance of a heart-lung machine, which keeps the function of both the heart and lungs uninterrupted throughout the surgery.
The doctors gain access to the surgical site by creating an incision on the chest through the breastbone. After getting access, the defective aortic root portion will be surgically eliminated, which is immediately followed by the introduction of a graft to seal off the structural deficit created by the resection. Following graft introduction, the coronary arteries stemming from the aortic root will be resecured with the graft, which nourishes the cardiac cells and muscles. Surgical closure of the incised site marks the end of the procedure. The patient will be kept under monitoring to keep track of the cardiac functions. It offers an average survival rate of 98 percent, which makes it a promising therapeutic option.
Are There Any Complications Associated With Aortic Root Replacement?
Being an extensive surgical technique, aortic root replacement is reported to have certain complications. Some of the routinely identified complications following ARR include the following:
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Graft Failure: It happens when the graft placed as a replacement for the defective aortic root portion fails to function the way it should. Sometimes, the graft may develop infections, potentially harming one's life.
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Bleeding: Since the surgery is carried out in the ultimate artery in the human body, it carries the potential risk of bleeding. The graft is often implanted in the desired location with the help of sutures, which may fail and allow blood to leak out.
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Nerve Injury: There are chances for the adjacent nerve to get traumatized during the surgical exploration.
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Blood Clot: Some patients are reported to develop internal blood clots, where clot formation occurs within the blood vessel. When such clots hinder the blood flow to the brain cells, it could even bring about stroke.
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Troubled Breathing: Breathing issues were also occasionally reported by patients who had undergone aortic root replacement.
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Organ Failures: Organ failures, though not very common, are also precipitated as a complication of aortic root replacement.
Conclusion
Aortic root replacement is a life-saving procedure for heart patients who are detected with both aortic valve and root defects. It is proven to be an effective and successful therapeutic intervention. Within six weeks, the patient recovers completely. Cardiac rehabilitation programs enhance the patient's quality of life and speed up recovery. The patients should refrain from stressful and physically demanding tasks as they may overburden the heart. With expert and skilled specialists and proper post-operative care, ARR successfully extends the person's longevity.
