Aortic Root Surgery The aorta is the big blood vessel that moves blood from the heart to the rest of the body. The aortic root is the part of the aorta nearest to and connected to the heart. An aneurysm is an unusual bulge in an artery's wall. When an aneurysm forms in the aortic root, it can cause the aorta to expand and the aortic valve to leak (regurgitation). If the aneurysm keeps growing, it might burst. The layers of the aortic wall can also tear (aortic dissection). This can lead to dangerous internal bleeding. Doctors carry out aortic root surgery to stop or treat an aortic aneurysm. They can do this in two ways: without cutting you open or through open-heart surgery. Your specific health situation will determine which method they'll use.

Types of Aortic Root Repair/Replacement

• Valve-Sparing Aortic Root Replacement: This surgery repairs aortic root aneurysms and keeps the patient's own aortic valve. Keeping the existing valve means no need to take blood thinners long-term and helps the valve last longer.
• Composite Aortic Root Replacement (Modified Bentall): This operation repairs the aortic root and swaps out the damaged aortic valve with an artificial one.
• Homograft Valve/Root Replacement: In complicated cases (like endocarditis or when someone's had many root surgeries before), doctors might use tissue from a donor's heart to replace the valve or root.

How to get ready for the procedure Before you have the procedure, your doctor and care team will tell you what to expect. They'll explain what will happen before, during, and after, as well as any possible risks. Make sure to talk to your doctor about:

• All medicines, herbs, and supplements you take now, and ask what they think about each one.
• Diabetes and how to change your medicine on the day of the procedure.
• X-ray exposure if you are pregnant.
• Any allergies to drugs, latex, tape, iodine, or numbing agents.
• Any history of bleeding issues
• Any device in your body (like a pacemaker or ICD)
• Any piercings on your chest or belly Your doctor will advise you:
• Have a regular dinner the night before your procedure. But don't eat, drink, or chew anything after midnight on the day of your procedure. If you need to take medicines, do so with small sips of water.
• Don't bring any jewelry with you.
• Take off all makeup and nail polish.
• Wear comfortable clothes when you come to the hospital.

What to expect before the procedure Before the procedure, your doctor might run several diagnostic tests, such as:

• Cardiac Catheterisation
• Computed tomography (CT scan)
• Magnetic Resonance Imaging (MRI)
• Echocardiogram (ECHO)
• Blood test, CXR

During the Procedure Aortic root surgery lasts 4 to 6 hours, but preparation and recovery might add several more hours. Ask your doctor about the specifics of your procedure. In general, the procedure involves:

• You'll be positioned on the operating table
• A medical staff will start an IV line in your arm to give you medicines and fluids during the procedure.
• Before the procedure starts, your doctor will give you general anesthesia.
• After you're sedated, your doctor might put a breathing tube through your throat into your lungs and hook you up to a ventilator. This will breathe for you during the operation.
• The procedure starts when your doctor exposes your heart by splitting the breastbone (sternum) in half. Your doctor then spreads both halves to access your heart (open-heart surgery).
• To perform this surgery, your heart needs to stop beating. Before this happens, your doctor will insert tubes into your heart. These tubes allow a heart-lung machine to pump blood through your body. This machine does the work of your heart by pushing blood and adding oxygen to it just like your lungs do.
• After your blood flows into the bypass machine for pumping, your doctor will stop your heart. They do this by injecting a cold solution into it.
• Once your heart stops, your doctor will repair the aortic root and put in a new aortic valve. This new valve is made of artificial materials.
• Once this process is done, the doctor will watch as blood flows through this new valve to ensure it works well. After checking, the doctor will allow the blood from the bypass machine to return to your heart.
• Your doctor might also place temporary pacing wires in your heart. These wires can link to a pacemaker, if needed, during your early recovery.
• When the procedure is over, they will turn off the heart-lung machine. They'll take out the tubes and close up the breastbone using stitches or surgical staples.
• After the procedure, your doctor will transfer you to the recovery room and monitor your vital signs till you recover.