Valve-sparing aortic root replacement removes damaged portions of your aorta, but allows you to keep your native aortic valve. It’s suitable for some people under age 65 who need surgery to treat an aortic aneurysm but have a healthy aortic valve. Keeping your valve lowers your risk of complications after the surgery and improves your outlook.
Valve-sparing aortic root replacement is a surgery that replaces the part of your aorta that’s directly attached to your heart (aortic root) while keeping your natural (native) aortic valve. Your aortic root connects with your heart at your left ventricle, which is your heart’s main pumping chamber. Your aortic root contains your aortic valve. Your aortic valve is the “door” that manages blood flow from your left ventricle to your aorta.
Your heart pumps blood through your aortic valve with each heartbeat. When your heart contracts (systole), the leaflets (flaps) of your aortic valve open to let blood flow into your aorta. The flaps then close to keep blood from flowing backward into your heart when your heart relaxes (diastole).
Some people have a damaged aortic root but healthy, or only mildly diseased, valve flaps. In that case, there’s no need for a new aortic valve. All you need is a new aortic root and potentially sparing or preservation of your valve flaps. But in the traditional aortic root replacement surgery (composite graft replacement, also known as the Bentall procedure), a surgeon replaces both your aortic root and your aortic valve.
Valve-sparing aortic root replacement offers an alternative to the Bentall procedure. It replaces your aortic root but allows you to keep your natural aortic valve. Keeping your aortic valve, rather than receiving a new valve, is a better option for many people. It avoids many of the risks associated with valve replacement and generally has excellent outcomes, especially at high-volume surgical centers with experienced surgeons who do many of these operations. Also, with valve replacement with a mechanical valve, you’ll need to be on the blood thinner Coumadin for the rest of your life.
Valve-sparing aortic root replacement treats:
The wider any portion of your aorta grows, the greater your risk for complications like an aneurysm rupture or dissection. People with certain inherited connective tissue disorders, such as Marfan syndrome, face a higher risk of aortic root aneurysms and associated complications.
So, surgeons weigh the risks of surgery with the risks of complications in deciding if and when a person needs surgery. Surgeons evaluate each person individually to see if valve-sparing aortic root replacement, as opposed to the Bentall procedure, is right for them.
Valve-sparing aortic root replacement has excellent short- and long-term outcomes in properly chosen candidates. You may be a candidate for this surgery if your aortic valve:
There are two main techniques surgeons use to replace your aortic root while keeping your aortic valve:
This article covers modified reimplantation surgery. Surgeons typically choose reimplantation surgery for people who:
Surgeons have modified the reimplantation technique to improve its durable long-term outcomes. These modifications are discussed later under procedure details.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Your surgeon will give you detailed instructions as you prepare for your surgery. It’s important to follow them closely. In general, you may need to:
Your surgeon will order tests to help plan the details of your surgery. These may include:
You’ll also talk with your surgeon about:
During your appointments, don’t hesitate to ask any questions that come up. It’s important that you fully understand what you need to do and what you can expect.
Valve-sparing aortic root replacement usually takes four to six hours, and your heart is usually stopped for an hour by an experienced surgeon. To perform a valve-sparing aortic root replacement, your surgical care team will perform the following steps. (There are modifications to this procedure that you can read about in the next section.)
Over the years, surgeons have made changes to the standard reimplantation surgery to improve its outcomes. For example, Dr. Lars Svensson’s modifications include the following:
You can talk to your surgeon to learn more about the specific techniques they may use.
You can expect to spend a day or two in the intensive care unit (ICU) before moving to a regular hospital room. Most people go home in about four days to one week. Before you leave, you’ll have a repeat echocardiogram and chest CT scan to check that all is well with your repair. You can think of this as your “graduation picture.”
While you’re in the hospital, your care team will closely monitor you to make sure you’re recovering as you should. You’ll be hooked up to tubes to drain fluids, and you’ll receive medications to ease your pain and prevent blood clots.
It’s essential to follow your care team’s instructions and take things slow. Pushing yourself too hard, too fast can set back your recovery.
You won’t be able to drive until your provider says it’s safe. So, make sure to arrange for someone to drive you home when you’re discharged.
Valve-sparing aortic root replacement (reimplantation) has several benefits over the Bentall procedure, including:
This surgery has excellent short- and long-term outcomes, particularly when performed at high-volume centers by experienced surgeons. Research shows:
Valve-sparing aortic root replacement is a major surgery and requires a skilled and experienced surgeon. Like other major surgeries, it carries risks and complications, but these are uncommon. These include:
It’s important to talk to your surgeon about your individual level of risk based on your overall health and underlying medical conditions. In experienced surgical hands, risks are minimal.
Full recovery usually takes six weeks. Participating in cardiac rehab can support your recovery and help you get back on your feet again sooner. It can also help to meet other people who are going through the same experiences as you.
During and after your recovery, you’ll meet your surgery team for follow-up appointments. They’ll tell you how often you need to come in.
After you feel better, it can be easy to think follow-ups aren’t necessary. But they are. Your care team, including your cardiologist, will monitor you long-term through routine imaging tests to make sure your heart and blood vessels are healthy. So, be sure to go to all of your appointments and be an active partner in your care.
Your surgeon will tell you when you can return to your usual activities. Most people have to wait at least six weeks to:
However, many people have returned to professional sports after a modified reimplantation, such as NBA players.
Call your provider immediately if you experience signs of a complication after your surgery, including:
A note from Cleveland Clinic
Valve-sparing aortic root replacement can help protect your heart and health for many years to come. Seeking care at an experienced hospital that routinely performs these surgeries gives you the best chance of a successful outcome.
It’s normal to feel scared or nervous going into any major surgery. Your surgeon will understand this, and they’ll help you feel comfortable with the process. Don’t hesitate to ask any and all questions that come to mind. This is the time to get all the information you need and make sure you understand what will happen before, during and after your surgery.
It’s also important to tell your family and friends about your surgery and ask for their help. Having a community of support around you as you recover can make a huge difference as you get back to your normal routine.
Last reviewed by a Cleveland Clinic medical professional on 01/23/2023.
Learn more about our editorial process.