Aortic Root Aneurysms  Surgical Treatments
David Procedure
The patient is placed on the heart-lung machine.
The heart is cooled and arrested and a clamp is placed across the aortic valve.
The aorta is transected just above where the coronary arteries originate.
The coronary ostia are removed as small buttons of tissue.
The remainder of the ascending aorta is removed except for the valve tissue.
Sutures are placed under the valve and passed outside of the aortic annulus.
A proper vascular graft is selected and attached to the heart with the above sutures.
The valve is then carefully positioned within the graft to eliminate leaking.
The valve tissue is completely attached to the graft with a continuous suture technique.
Two small holes are created in the graft for attachment of the coronary arteries.
Finally the end of the graft is attached to the aortic arch while the brain is carefully protected with a special perfusion technique known as antegrade cerebral perfusion (ACP).
(To learn more about ACP, please click here.)
Homograft Root Replacement
The steps detailed above are identical except that the aortic valve tissue is also removed.
The aortic annulus is measured an appropriately sized donor aorta is selected.
(Since the Morgan Stanley Children's Hospital of NewYork-Presbyterian is attached, we retain a wide range of homograft sizes).
The homograft is trimmed to size and attached with a continuous suture to the heart.
The coronary arteries and end connection (distal anastomosis) are identical to the description above.
Mechanical Valve Conduit
The steps detailed above for homograft replacement are identical.
An appropriate mechanical valve conduit is selected and connections are carefully constructed.
Transcatheter Aortic Valve Relacement
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The Edwards Sapien transcatheter aortic heart valve integrates balloon-expandable stent technology with a replacement tissue heart valve. |
During the procedure, a catheter is advanced to the aortic valve, either through the femoral artery or transapically, through a small chest incision and through the left ventricle.
Once the catheter is in place, a tissue valve with metal stent scaffolding is positioned and deployed.
X-ray guidance provides indirect visualization.
The force of the expanding stent anchors the new valve in place, completely avoiding the need for sutures, cardiopulmonary bypass, open surgery—and their associated effects.
Endovascular Stent Graft Aneurysm Repair
Traditionally, repairing a descending thoracic aortic aneurysm required high-risk open heart surgery and involved a large chest incision.
Patients experienced long hospital stays, and recovery was painful.
In this minimally invasive procedure, a stent graft comprised of a layer of impermeable reinforcement material enclosed by a self-expanding metal support mesh is placed at the aneurysm site.
To implant the stent graft, the physician inserts a catheter through the femoral artery in the groin. The stent graft is then delivered through the catheter in a collapsed state and deployed at the site of the aneurysm.
The device replaces and reinforces the diseased aortic wall, ensuring continuity of blood flow. The benefits of the procedure include greatly reduced risk, a shorter hospital stay, and a more rapid recovery.
NewYork-Presbyterian-Columbia participates in the Bolton-RELAY stent graft clinical trial. Read more about the trial.
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