Bio-Bentall and ascending hemiarch and proximal arch repair for aortic dissection and rupture
Cardiac surgical teams are performing life-saving surgeries for acute aneurysms and dissection of the ascending aorta at the Penn Aorta Center.
Cardiac surgical teams at the Penn Aorta Center are performing advanced life-saving surgeries for individuals with acute aneurysms and dissection of the ascending aorta and aortic arch. These surgeries include valve-sparing (David) procedures, Bio-Bentall procedures, which replace the aortic valves and ascending aorta, and ascending hemiarch and proximal arch repairs.
Aortic aneurysm and dissection have a cause-and-effect relationship in that the luminal dilation that leads to aneurysm is the direct cause of dissection. Dissection involves a tear within the walls of the aorta that permits blood to collect within and separate the vessel layers.
Thoracic aneurysm and dissection are often considered a conjoined condition known as TAAD. Exceptionally common in individuals with bicuspid aortic valves (BAV) and the heritable connective tissue disorders, TAAD can be lethal when acute.
This is particularly true of acute aneurysms and dissections affecting the ascending aorta (type A), which have a mortality rate of 2% per hour unless treated with emergent surgery.
Creators of the University of Pennsylvania classification system (Penn class) of acute type A aortic dissection (aTAAD), Penn Cardiac surgeons are internationally recognized for their comprehension of the nuances of TAAD, and particularly for innovation in aortic valve repair and complex stent-based repairs involving acute aneurysmal rupture and dissection.
Affiliated with the Penn Aorta Center, the team performs aortic root operations to repair, replace, or preserve a patient's heart valve, reduce Type A dissection mortality through a trauma-oriented approach, and employ percutaneous branched endovascular stent grafts (customized when needed) to replace and/or support the aortic continuum.
Case report
Mr. Crane, a 75-year-old man, came to Penn Cardiac Surgery via a circuitous route. Diagnosed with pneumonia in the Fall of 2024, he spent three weeks in a community hospital outside of Philadelphia and had a prolonged and difficult recovery thereafter.
While in the hospital, a series of tests revealed aortic dilation, and he was scheduled for a chest CT angiogram (CTA) shortly after leaving the hospital.
The CTA revealed gross dilation of the ascending aortic artery and evidence of an evolving dissection. On counseling in the outpatient waiting room, Mr. Crane acknowledged having chest flutters and cold sweats in the days prior to the test but no other pain or discomfort. When it was suggested that he go immediately to the ER, however, he refused—citing his recent prolonged hospitalization and the need to care for his nine-year-old grandson, for whom he was the sole caregiver—and left the hospital.
After an urgent consult with his cardiologist, Mr. Crane returned to the hospital, which has a standing relationship with the Penn Aorta Center, home to a thriving Direct-to-OR program. Mr. Crane’s scans were transmitted to the Penn Aorta Center, and shortly thereafter, he was transferred via helicopter to Penn Presbyterian Medical Center (PPMC). There, after consultation with his surgical team, which would include cardiac surgeon Chase Brown, MD, cardiac anesthesiologist Asad Ali Usman, MD, and cardiac surgery resident Amit Iyengar, MD, MS, he consented to surgery to repair his heart.
Because Mr. C was on blood thinners at arrival, a 48-hour wash-out period took place before surgery. During this time, further imaging of his chest found a 7.7 cm diameter aneurysm at his ascending aorta and evidence of a type A dissection with a contained rupture from the root under the right pulmonary artery, resulting in a near complete block of blood flow to his right lung
The procedure
Following preparation for surgery, Mr. C was placed on cardiopulmonary bypass, and a sternotomy was performed for a planned Bio-Bentall repair of his ascending hemiarch and proximal arch.
This seven-hour operation would address his dissection and rupture by replacing his aortic root (including the valve) and ascending aorta with a graft comprised of a biological (bovine) valve and a cobalt-chromium stent enveloped in woven polyester. A flexible Dacron graft would then reconstruct the ruptured aorta. The right pulmonary artery was then reconstructed to resolve the occlusion caused by the rupture.
Mr. C tolerated these procedures well and following his surgery was transferred to the cardiac ICU at PPMC for observation and continued rehabilitation. On post-op day five, having recovered well, he was deemed well enough to return home.
The first few days of Mr. C’s recovery at home were challenging, but to his surprise, he felt no pain at the sternotomy site. He experienced transient edema and anemia, but by his second month, he had transitioned from a wheelchair to normal walking and other activities.
Mr. C arrived with his grandson (see photo) to his most recent follow-up, and reported having regained much of the energy he’d experienced before his bout of pneumonia. He added that he’d recently married a long-time friend to ensure the future care of his grandson.
About the Penn Aorta Center
One of North America's four largest aorta programs, the Penn Aorta Center is the busiest aorta program in the greater Philadelphia region (by caseload). High volume means that Penn surgeons have experience in the full range of aortic interventions and see the most complex presentations, including emergent cases.
Penn aorta team colleagues publish globally influential research (>600 articles to date), with contributions that have helped change guidelines for earlier interventions in aortic insufficiency and Marfan syndrome. They also present at conferences worldwide and hold leadership positions in national and international societies and conferences.
Clinical consult and patient referral
To refer a patient to Penn Medicine, please call the 24/7 provider-only line at 877-937-7366 or submit a referral through our secure online referral form.