The surgical removal of some portion of diseased aorta is called aortic resection. A polyester graft is used to replace the diseased aortic tissue. The polyester grafts (such as Dacron) are an excellent example of successful substitution of a synthetic material within the human body. Dacron is so completely compatible with the body that rejection and calcification do not occur. With the passage of time, the body deposits its own tissue into the Dacron graft. Today's modern Dacron grafts are strong, flexible and collagen impregnated, making them impervious to blood. The durability of these grafts exceeds that of the human life span.
Surgery on the thoracic aorta is in some respects similar to other types of open-heart surgery. Details regarding the size and location of the incision, the use of the heart-lung machine and specialized techniques used to provide neurologic protection vary depending on the type of aortic surgery being performed.
Aortic disease often simultaneously affects some combination of the aortic valve, root, ascending aorta and arch. The arteries that branch from these aortic segments require special consideration during surgery. This includes the coronary arteries, which supply blood to the heart, as well as the arteries branching from the arch, which supply blood to the head and upper body. A combination of procedures may be used in one surgery.
There are several different procedures from which aortic surgeons may choose based on their assessment of an individual patient. Procedures and techniques include:
- Button Bentall with Bioprosthesis or Prosthesis
- David Valve-Sparing Re-Implantation Procedure
- Yacoub Remodeling Procedure
- Ross Procedure
- Porcine Root Replacement (Freestyle)
- Homograft Technique
The condition of the aortic valve, root, ascending aorta and arch taken together with the patient's overall health determine the surgical procedure that will be performed. Prior to surgery a strategy is developed based on what has been revealed by diagnostic testing. However, in some instances the final decision regarding the best approach is made during surgery itself.
The surgical procedures described here are the result of the continued pursuit of excellence in surgeries that may begin with the aortic valve and reach to the arch or be limited to some subset of these structures. Generally, for a surgical procedure to be successful, it must lend itself well to widespread usage across many surgeons and centers. Procedures that are too difficult to duplicate will not be widely adopted and will be replaced by a procedure that is easier to perform while maintaining good results. For example, if a brilliant valve-sparing operation cannot be duplicated easily, it will not be a viable procedure for use in most patients.