Patients who qualify for ascending aortic replacement
Asymptomatic patients with thoracic aneurysms for whom the ascending aorta diameter is 5.5 cm or greater should have surgical repair.
- Patients with Marfan syndrome or bicuspid aortic valve, or familial thoracic aortic aneurysm and dissection (patients with known family members with aneurysms or dissections) should undergo an elective operation at smaller diameters (4.0 to 5.0 cm) because they are at a higher risk for rupture or dissection compared to the general population.
- Patients with an aneurysm that grows more than 0.5 cm in a year in an aorta that is less than 5.5 cm in diameter should be considered for the operation.
- Patients undergoing aortic valve repair or replacement who have an ascending aorta greater than 4.5 cm should be considered for replacement of the ascending aorta.
- Patients with symptoms (usually chest or back pain) suggestive of expansion of a thoracic aneurysm should be evaluated for prompt surgical intervention. Chest or back pain in the presence of an enlarged thoracic aorta is a predictor of aortic rupture or dissection.
- Patients who develop acute aortic dissection commonly present with sudden onset of severe chest or back pain. These patients require emergent surgery to prevent death.
Multiple surgical procedures may accompany ascending aorta replacement
Aneurysms of the ascending aorta and aortic sinuses may result in symptoms related to the aortic regurgitation (leaking aortic valve) that develops as a result of the progression of the aortic enlargement. The usual early symptom is shortness of breath with walking or exercise. These symptoms can progress to severe shortness of breath with limited exercise and finally lead to congestive heart failure.
Ascending aorta replacement is performed when there is aneurismal enlargement or dissection of the aortic root. The ascending aorta is very often involved in this process, and it is replaced at the same time as the aortic root.
Ascending aortic replacement is performed for aneurysms or dissections that are located exclusively in the ascending aorta. If the aortic arch or aortic root are involved in the process, they can be replaced at the same time. Often aortic valve replacement or coronary artery bypasses can be performed at the same time if needed.