Valve-sparing root replacement allows surgeons to repair the aortic root while preserving the patient’s own aortic valve. For carefully selected patients, keeping the native valve—rather than replacing it with a prosthetic one—can lead to better long-term outcomes, including improved life expectancy. This approach avoids the need for lifelong blood thinners and reduces the risk of complications associated with artificial valves.
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What is aortic root replacement?
The aorta is the main artery in your body. It carries blood from your heart to the rest of your body. The aortic root is the first part of the aorta, attached to your heart. Aortic root replacement (ARR) is a procedure to replace the aortic root and aortic valve when they become weak or damaged. If the aortic valve still functions well, we may perform a valve-sparing root replacement (VSRR), replacing only the root while keeping your natural valve.
At Mass General Brigham Heart and Vascular, we offer advanced treatments for common to complex heart valve problems. Our Heart Valve Disease Treatment Program is one of the largest, most experienced in the nation with success rates above national and regional averages.
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Who needs aortic root replacement?
Aortic root replacement may be necessary if a bulge (aneurysm) or weakness develops in the aortic root. This kind of aortic root aneurysm can develop due to:
- Hypertension
- A genetic heart condition like Marfan syndrome or other aorta abnormalities
- Inflammation
- An injury to the aorta
The aortic root also may become too wide (dilated aortic root) because of an abnormality you were born with or through damage caused by disease. An enlarged aortic root becomes weak and leads to heart function problems.
A damaged or abnormal aortic root can eventually tear. When aortic root damage affects the function of the aortic valve, your surgeon may need to replace the valve along with the root.
Benefits of aortic root replacement
Aortic root replacement surgery prevents tears in the aorta that can lead to stroke, heart infection, or other life-threatening cardiac emergencies. Once you recover from surgery, you’ll be able to get back to activities you enjoy knowing you can live a longer, healthier life.
How to prepare for aortic root replacement
In the weeks before surgery, we’ll discuss the procedure, answer your questions, and help you understand what to expect. Your care team carefully guides you through preparation, which is critical to successful surgery. You’ll have several tests before the procedure, such as:
- Blood tests
- Coronary angiogram
- CT or MRI
- Duplex ultrasound
- Echocardiogram
- Electrocardiogram (ECG or EKG)
Your care team will tell you when to stop taking certain medications before surgery and when to stop eating and drinking the day before surgery.
What to expect during aortic root replacement
Aortic root replacement is an open-heart surgery that typically lasts four to six hours. You’ll have general anesthesia and sleep through the procedure. A team of specialists will monitor your oxygen levels, blood flow, blood pressure, and other vital signs during surgery.
Here’s what happens during aortic root replacement:
- Accesses the heart: The surgeon accesses your heart through an incision in the chest. This is most often done through a sternotomy (opening the breastbone), but minimally invasive approaches may be possible in some cases.
- Connects to a heart-lung machine: Places you on a cardiopulmonary bypass machine (heart-lung machine) to keep blood and oxygen circulating.
- Stopping the heart: The heart is temporarily stopped so the surgeon can work safely. This procedure cannot be done on a beating heart.
- Removing the damaged aortic root: The surgeon removes the diseased portion of the aortic root. If you are having a valve-sparing procedure, your own valve is left in place.
- Replacing the aortic root: The root is replaced with a synthetic graft—a durable fabric tube shaped like the natural aortic root.
- Replacing the valve (if needed): If your valve cannot be preserved, it is replaced with either a mechanical valve or a tissue valve.
- Restarting the heart and coming off bypass: Once the new root and valve are in place, the heart is restarted and you are gradually weaned off the heart-lung machine.
- Closing the incision: The surgeon closes the chest and incision with care to support healing.
Recovery from aortic root replacement
Most people stay in the hospital for four to six days, but everyone’s recovery is different. You'll rest in the cardiac intensive care unit before moving to a room in the cardiac step-down unit, where we closely monitor your progress. Your team provides pain relievers, blood thinners, and other medications as needed.
After discharge, you will see your care team for checkups and imaging tests to ensure the new valve works properly. Your care team may recommend participating in cardiac rehabilitation a month or so after surgery. This supervised program helps you safely return to activities and strengthens your heart.
It can take up to three months to fully recover from open-heart surgery. Your care team will provide instructions for caring for your incision and managing pain. They’ll also let you know when it’s safe to resume activities like driving.
If you have a mechanical aortic heart valve, you must take blood-thinning medications (anticoagulants) for life. These drugs lower the risk of blood clots that cause strokes. If you receive a biological (tissue) valve, you may not need lifelong blood thinners.
Risks of aortic root replacement
Our experienced surgeons are highly skilled at performing complex heart surgeries. However, any major surgery comes with risks. Possible complications of aortic root replacement include:
- Bleeding
- Blood clots
- Heart valve problems
- Infection
- Stroke
FAQs about aortic root replacement
The lifespan of an aortic root replacement depends on the type of valve used:
- Mechanical valves are very durable and can last a lifetime. However, they require lifelong use of blood thinners to prevent clots.
- Tissue valves typically last 10 to 15 years and do not usually require long-term blood thinners.
- Valve-sparing procedures preserve your own valve. In the right patients, the native valve can function well for the rest of your life.
Yes, this procedure involves temporarily stopping the heart. A heart-lung bypass machine keeps blood circulating through your body while the surgeon performs the replacement.
The diseased portion of the aortic root is replaced with a synthetic (fabric) graft. Depending on your condition, your aortic valve may be preserved (valve-sparing) or replaced. The type of valve used can affect how long the repair lasts.
We are highly skilled in carefully managing blood flow and oxygen during surgery and making sure you spend as little time as possible on the machine.
Some people only need blood thinners for a short time after aortic root surgery, but others need to take blood thinners for life. It depends on the type of valve used and your heart rhythm after surgery. If you receive a mechanical valve, you will need to take blood thinners for life to prevent dangerous blood clots. If you develop an irregular heart rhythm after surgery—such as atrial fibrillation (AFib)—you may also need long-term blood thinners.
Yes, you can lead a normal life after aortic root replacement. Most people even have a better quality of life than before surgery. Attending all follow-up appointments and following the instructions from your providers will help you live the fullest and healthiest life possible.
It is possible to have a safe and healthy pregnancy after you’ve fully recovered from aortic root replacement. However, pregnancy can put additional strain on the heart, and your pregnancy may be classified as high-risk. To understand and minimize risks, discuss your plans for pregnancy with your providers. Mass General Brigham offers comprehensive services for high-risk pregnancies. Experts from different specialty areas collaborate to provide personalized care for women living with heart conditions who are or plan to become pregnant.
