The Button Bentall procedure is used to replace the aortic valve, aortic root, and the entire ascending aorta with a DacronŽ graft. The coronary arteries, which supply blood to the heart, are implanted in the Dacron graft. Please see the Button Bentall Procedure section of this website for further details.
The elephant trunk is used to facilitate future replacement of the descending aorta. It is used as a prelude to the second stage surgery. During the second surgery the attachment of the Dacron graft replacing the descending aorta is sewn to the edge of the elephant trunk. (It takes less time to sew two Dacron grafts together with this technique.)
When surgery on the aortic arch is done, it is important to provide special neurologic protection for the brain. This is done through lowering the temperature and slowing the brain metabolism during the time circulation is arrested and the arch is being repaired. Please see the Open Anastomosis with Hypothermic Circulatory Arrest section of this website for further details.
As a result of incisional pain after surgery, most patients avoid deep breathing. As a result the lungs do not fully expand, and this produces postoperative fever and a poor cough mechanism that leads to inadequate clearing of lung secretions (phlegm). Deep breathing not only alleviates the postoperative fever, it helps the clearing of lung secretions.
In general, elective surgery is scheduled when the risk of aortic dissection or rupture is greater than the risk of the surgery performed by an aortic specialist. Many people will never experience symptoms due to an aneurysm, so it is important to understand that it is not possible to wait for symptoms to appear. Aortic dissection or rupture is life threatening, and patients may not survive long enough to reach an emergency room or undergo surgery. Please see the Timing of Elective Surgery section of this website for further details.
The risk of elective aortic surgery today has declined considerably. Today in expert hands the recommendation for surgical intervention for those with bicuspid aortic valves ranges between 4 cm and 5 cm. Younger people with aortic valve insufficiency and a dilated aorta are more prone to aortic dissection and rupture, and elective surgery should be planned sooner rather than later in these patients. At Cedars-Sinai, the patient is placed on appropriate medical therapy with close diagnostic follow up, and when the maximum aortic diameter reaches 4.5cm, surgical correction is recommended. Please see the Timing of Elective Surgery section of this website for further details.
Two factors have contributed to a trend toward the use of tissue valves today. One is the impact on people's lives when taking Coumadin. Those who are physically active wish to avoid the risks associated with bleeding while on Coumadin. National and international trends have clearly proven that for the majority of patients young or old, the quality of life is much better without the use of life-long anticoagulation with Coumadin. If that is important to the patient, then use of a bioprosthesis (tissue valve) is preferable to a prosthesis. Secondly, certain tissue valves, such as the bovine pericardial valve, have now demonstrated durability well beyond ten years, making them a very good choice. Also, the next generation of bioprosthetic valves potentially will have appropriate longevity that could last the life of the patient.
