Let's learn about Valve-Sparing Aortic Root Replacement in simple terms.

Has your doctor told you that your aortic root is a little enlarged and that you need surgery? It's normal to feel a little scared and anxious when you hear that. Who doesn't like the word "heart surgery"? But don't worry. Technology is very advanced today. Today, we're going to talk about a very successful, special surgery that solves this problem without removing the most valuable part of your heart, which is your own natural 'valve'.

What is Valve-Sparing Aortic Root Replacement?

To understand this, let's first take a simple look at how the heart works. Think of your heart as a water pump in your home. This pump pumps blood throughout your body.

• Aorta: This is the main, largest tube that exits the heart. It carries blood to the entire body.
• Aortic Root: This is the first part of the main artery that connects to the heart. It's like where you attach a tube to a motor.
• Aortic Valve: This is the most important part of the story. Where it connects to the heart, there is a part that acts like a door. When the heart pumps blood, this door opens, letting blood out. Then this door closes to stop blood from coming back into the heart. This is what we call the `(Aortic Valve)`.

Now, in some people, the root of this great artery that connects to the heart, the `(Aortic Root),` becomes a little weak and starts to bulge and get bigger like a balloon. We call this `(Aortic Root Aneurysm)`. When it gets bigger like this, that door, that valve, doesn't close properly. Then the blood starts to leak backwards, `(Aortic Regurgitation)`.

In the past, when this type of problem arose, surgeons removed both the aortic root and the aortic valve, and replaced them with an artificial aortic root and valve. This surgery is called the Bentall procedure .

What conditions are treated with this surgery?

This surgery is mainly performed for a condition called `(Aortic Root Aneurysm)`. This means when the root of the aorta is swollen like a balloon. This can be dangerous, because if it gets bigger than a certain limit, it can burst (rupture) or tear (aortic dissection).

Some people have genetic connective tissue disorders, such as Marfan syndrome. People with these conditions are at higher risk of developing an aortic root aneurysm.

Who is suitable for this surgery?

Your doctor will perform various tests to determine if you are a good candidate for this surgery. In general, you may be a good candidate for this procedure,

• If your Aortic Valve has very little or no calcification.
• Unless the valve is severely damaged.
• If the valve is working well, or can be fixed with a minor repair.
• This surgery is especially recommended for people under the age of 75 and those with genetic diseases.

How do you prepare before surgery?

Since this is a major surgery, it is very important to prepare well for it. Your surgeon will give you a clear set of instructions about this.

• Medications: You should tell your doctor about any medications you are currently taking. He or she may ask you to stop or change some medications (especially blood thinners) before surgery.
• Fasting: You will be asked not to eat or drink anything after midnight the night before the surgery. Don't even drink water.
• Tests: The doctor will order several tests to plan the surgery.
• Echocardiogram (a scan of the heart)
• Blood tests
• EKG gated CT scan
• Heart MRI
• Coronary Angiogram
• Smoking: If you are a smoker, it is imperative that you stop smoking completely at least one month before surgery.
• Ask questions: Talk openly with your doctor about any concerns or fears you have. It will be a great relief to know everything clearly.

How is the surgery done?

This surgery usually takes between 4 and 6 hours. When performed manually by an experienced surgeon, the heart is stopped for a short time, about an hour. The steps involved in this process are simply as follows.

1. Anesthesia: First, you will be given anesthesia to put you into a deep sleep. So you won't feel any pain.

2. Opening the chest: The doctor makes an incision in the middle of the chest (median sternotomy) to access the heart.

3. Heart-lung machine: Next, you will be connected to a heart-lung machine (cardiopulmonary bypass machine). This machine will do the work of your heart and lungs during the surgery. It will also give you medicine to temporarily stop your heart.

4. Valve separation: The surgeon will carefully separate your aortic valve from the surrounding tissue.

5. Repair: If there is any minor damage to the valve flaps, it is repaired immediately.

6. Removing the damaged part: The swollen and damaged part of the `(Aortic Root)` is cut and removed.

7. Artificial tube implantation: Instead, an artificial tube ``graft`` made of a special fabric is taken, made to the right size for you, and implanted in that place.

8. Reattaching the valve: Then , your own natural valve , which was carefully removed, is placed inside the newly implanted tube and sewn back together (reimplant).

9. Checking: Check to see if everything is OK, whether the valve opens and closes properly, and whether there are any leaks.

10. Closing: The coronary arteries that supply blood to the heart are then connected to the new graft. You are removed from the heart-lung machine and once your heart starts working again, the incision in your chest is closed.

11. Final checkup: Before being taken out of the operating room, a ``transesophageal echocardiogram'' is performed to confirm the success of the surgery.

Modern improvements in surgery

Over time, doctors have added new techniques to make this surgery more successful.

• Annulus reduction: Simply put, the base that holds the valve (aortic annulus) is compressed to fit your body. This will prevent blood from leaking from the valve in the future.
• Creating New Aortic Sinuses (Neosinuses): The root of the natural aorta has small vibrations. Since the new graft is a straight tube, it also creates small vibrations. This makes the blood flow more natural and reduces damage to the valve leaflets.

What are the benefits of this surgery?

This surgery has several major advantages over the traditional Bentall surgery (which involves replacing the valve along with the valve).

How long does it take to recover after surgery?

After the surgery, you will be kept in the intensive care unit (ICU) for a day or two, then transferred to a regular ward. You can usually go home from the hospital in 4 to 7 days.

During this time,

• Participating in a cardiac rehabilitation program is a great idea. It will help you recover faster and become stronger.
• The doctor says not to do anything like lifting weights or driving for about 6 weeks.
• Follow-up appointments: You may not think you need to see your doctor again after you've recovered. But it's important to do so . It's important to keep your heart condition under regular checkups.

When to call the doctor immediately

After returning home, if you develop any of the following symptoms, call your doctor immediately or go to the nearest hospital's Emergency Department (ETU).

It's normal to feel nervous before any major surgery. But remember, this surgery is being done to save your life and help you stay healthy for a long time. Talk to your family and friends about this. Their support will be a great strength to you during this time.