Surgery for Aortic Aneurysm

Our surgical team specializes in valve-sparing aortic root replacement, also known as the David procedure. This open surgery may be offered to people who have an aortic root aneurysm, often accompanied by aortic valve regurgitation. It is performed to preserve the aortic valve instead of replacing it with an artificial valve.

Doctors remove the section of the aorta affected by the aneurysm and replace the tissue with a synthetic tube called a graft. The left and right coronary arteries, which originate from the aortic root, are carefully detached from the diseased portion and then reattached to the graft in their proper locations.

In some cases, surgeons may perform a hemiarch replacement procedure, in which a graft replaces the ascending aorta, or the section of aorta directly above the aortic root. The surgeon then places the patient’s own aortic valve inside the graft, to preserve normal valve function.

A valve-sparing aortic root replacement can help you avoid the need for long-term use of anticoagulant medication, also known as a blood thinner, or additional surgery to replace animal tissue valves, which eventually wear out.

NYU Langone cardiac surgeons specialize in the Ross Procedure, an innovative treatment that is an option for some people who have both an aortic aneurysm and aortic valve disease. The open procedure is particularly beneficial for young, active patients. At NYU Langone, we have performed more Ross procedures than almost anywhere else in the nation.

During surgery, surgeons remove the enlarged section of the aortic root and replace it with a synthetic graft, eliminating the aneurysm. They also replace the diseased aortic valve with your own pulmonary valve, which normally handles blood flow from the heart to the lungs. The pulmonary valve is flexible and strong, enabling it to take over the job of the aortic valve. An artificial valve replaces your original pulmonary valve.

Because the Ross Procedure uses your own valve tissue, it often functions more like a natural heart valve. It can also last many years, and does not typically require lifelong use of blood thinners—as some artificial valves do.

Aortic arch aneurysms usually require surgery to replace the arch and vessels. Our surgeons may recommend a hybrid procedure. This includes open surgery followed by a stent graft placed with EVAR to seal and strengthen the wall of the aorta, allowing the aneurysm to shrink. We also perform aneurysm repair in patients who previously had this surgery at another institution but who had poor results.

When a thoracoabdominal aneurysm needs to be repaired or replaced, there is a risk of reduced blood flow to the liver, kidneys, intestines, and spine. Our surgeons have extensive experience in the techniques used to create bypasses that maintain blood flow to these organs and the spine. They may use EVAR to shore up the aorta, while also allowing blood to flow through its connected veins and to vital organs.