Valve-sparing aortic root replacement

The aortic valve sits between the heart and the beginning of the aorta, the large artery that carries blood to the body. When an aneurysm (a weak, bulging area) forms at this spot, called the aortic root, the aorta can stretch too much. This can make the aortic valve leak and increase the risk of aortic dissection, a dangerous tear.

To preserve the aortic valve (native valve), Penn Medicine’s cardiac surgeons offer valve-sparing aortic root replacement (VSARR) surgery, also known as the David Procedure. Whenever possible, we strive to keep the native valve intact with small repairs because it has better durability than a completely artificial valve. It also helps avoid the lifelong anticoagulation (blood-thinning) therapy that is necessary with a replacement valve. When preserving the native valve isn’t possible, our surgeons provide leading-edge aortic valve repair and replacement surgery.

Cardiac surgeons at Penn Medicine’s Aorta Center have unmatched expertise repairing aneurysms that exist at the aortic root. As a high-volume center, we routinely perform technically challenging procedures like aortic valve-sparing surgery. Our heart surgeons are sought after for using complex surgeries to help those with high-risk conditions.

VSARR is often the recommended treatment for people who need surgery on their aorta but have healthy aortic valve leaflets, the thin, flexible flaps that open and close to control blood flow. People with Marfan syndrome or bicuspid aortic valve may be good candidates because these genetic conditions can cause aortic root problems without significant damage to the valve itself, making it possible to repair the aorta while preserving the valve.

VSARR eligibility requirements also typically include people who:

• Are under 70 years old
• Have a life expectancy of more than 15 years post-surgery
• Cannot take long-term blood thinners

Your Penn Medicine care team will assess your specific condition to determine if VSARR is the best option for you.

In preparation for VSARR, you’ll likely undergo a series of pre-operative tests, including blood work, imaging studies like CT scans or MRIs, echocardiograms, and possibly genetic testing. You may be asked to have a dental check-up, adjust medications, and follow specific fasting instructions.

Before surgery, a specially trained cardiac anesthesiologist will place you into a deep and comfortable sleep. Your surgeon will then perform the VSARR procedure, which includes these steps:

• Making an incision in your chest and placing you on a heart bypass machine, which temporarily takes over the job of your heart and lungs
• Clamping the aorta and carefully removing the enlarged section of the aorta, along with the valve
• Detaching the aortic valve from the damaged area, then stitching it into a synthetic tube (graft) that will replace the diseased part of the aorta
• Attaching the graft containing your valve back to the heart and connecting the upper part of the graft to the remaining healthy portion of the aorta

After your VSARR surgery, you’ll usually spend one or two days in the intensive care unit (ICU) for close monitoring. Most people remain in the hospital for four to seven days in total before being discharged. Before you leave, doctors will perform a repeat echocardiogram and chest CT scan to make sure the replacement was successful.

To support healing, follow-up appointments with your surgical team are essential. Participation in cardiac rehabilitation is often recommended as part of the VSARR post-surgery recovery guidelines. In cardiac rehab, specialists provide personalized exercise routines, nutrition advice, and ongoing support to help you recover fully.

VSARR recovery time varies, but most people are able to resume normal activities within six to eight weeks. Your care team will give you specific instructions on when you can return to work and resume other daily activities.

Risks and potential complications of aortic valve-sparing surgery include:

• Bleeding
• Blood clots
• Breathing problems
• Heart attack or stroke
• Infection in the graft, lungs, urinary tract, or abdomen
• Complications with kidney function
• Need for a pacemaker to correct heart rhythm problems
• Valve-related complications like valve leakage, cusp damage, or improper valve closure
• Need for additional surgery

These risks are uncommon, and the long-term outcomes of VSARR are typically excellent. Your surgeon will discuss your specific risk factors with you.

The Aorta Center at Penn Medicine is a world leader in treating aortic root aneurysms. Our cardiovascular surgeons are highly experienced in aortic disease procedures and are recognized as top doctors both regionally and nationally.

Choosing Penn Medicine for your VSARR procedure means you’ll benefit from:

• Teamwork: In just one visit, you’ll meet with multiple specialists, including cardiac and vascular surgeons, geneticists, nurse practitioners, and imaging experts.
• Diagnostic excellence: We use advanced imaging technologies like echocardiography, CT scans, and MRI tests to ensure precise diagnoses.
• Less invasive options: As pioneers in endovascular artery repair, we’re among the top centers worldwide that offer minimally invasive treatments for aortic disease.
• Innovation: Our commitment to clinical research allows us to provide advanced treatments that may not be available anywhere else in the region.