Life-Saving Treatment

Currently, there is no "cure" for thoracic aortic disease once there is degeneration of the tissue. Once present, regardless of the underlying cause, medical and surgical treatment options are available. Aortic surgery has advanced significantly, over a period of about three decades, saving many lives.

Thoracic Aortic Disease - Open Aortic Surgery Surgery for Aortic Root, Ascending Aorta, and Aortic Valve Button Bentall Technique When the aortic valve, entire aortic root, and ascending aorta must all be replaced, a technique called the Button Bentall is currently available. Because the root is being removed, the arteries that branch off the root and provide blood to the heart (coronary arteries) need to be sewn to the new aorta, the Dacron graft. The "buttons" are the circles of aortic tissue that were left around the openings of these coronary arteries. The coronary arteries are attached to the Dacron aortic graft by sewing these buttons of aortic tissue to it. The aortic valve is typically replaced either with a biological valve or a mechanical valve. The original Bentall technique used a mechanical valve. When the new aortic valve is made of biological tissue, this is called a Bio Bentall procedure. If the aortic valve is appropriate for repair, the entire aortic root is removed and is replaced with a Dacron graft, leaving a small rim of aortic tissue attached to the aortic valve. The coronary arteries are re-attached to the side of the Dacron graft (aortic root remodeling technique). Aortic Root Remodeling An alternative to the button bentall is to “remodel” the aortic root. This allows the coronary arteries to remain attached to the root, but other areas are removed and replaced with the Dacron graft which has been custom fit to the remaining root. Removal of Entire Ascending Aorta The majority of aortic surgeons emphasize the importance of removing the entire ascending aorta, all the way to the beginning of the arch. When all of the ascending aortic tissue is removed, it cannot develop another aneurysm later. In order to do this safely, the aortic arch is left open and sewn to the Dacron graft without use of an aortic clamp (open anastomsis). This technique is done safely under total circulatory arrest and profound hypothermia (TCA), preferably in less than 40 minutes. During surgery on the ascending aorta, the diseased, aneurysmal tissue is completely removed. Earlier techniques kept the aneurysmal aortic tissue, and it was wrapped around the Dacron graft (inclusion technique). This technique has almost disappeared over time due to a higher incidence of pseudoaneurysm formation at the suture line. Therefore, this is no longer considered a desirable surgical approach. In summary, in the majority of these cases: • the ascending aorta is removed all the way to the base of the innominate artery • total circulatory arrest is used • the aortic valve may be left as is, repaired, or replaced.