Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Houston Methodist DeBakey Heart & Vascular Center

Open Surgery

Open Aortic Aneurysm Repair

Open aortic aneurysm repair is a surgical procedure to repair a bulge in the aorta known as an aortic aneurysm. Because of the severe complications that can arise, an aortic aneurysm should be treated, even if you have no symptoms, if:

  • It is 5 cm or larger in diameter, or
  • It grows by more than 0.5 cm every 6 months

Open surgical correction of the aorta is done under general anesthesia. The surgeon removes the weakened part of the vessel and replaces it with a synthetic material called a graft.

Most aneurysms in the descending aorta occur below the level of the arteries feeding the kidneys, but they can occur anywhere along its course. The surgical approach depends on the location of the aneurysm:

  • Aortic aneurysms in the chest (thoracic aortic aneurysms or TAAs) are approached through an incision on the left side, through which the surgeon works from between the ribs.
  • In the case of an abdominal aortic aneurysm (AAA), the surgeon approaches the aorta through the belly.

The average stay in the hospital after open aortic aneurysm surgery is 7 days, and most patients are able to go back to work within 4 to 6 weeks.

Aortic Root Repair

The aortic root is a short tubular segment that starts immediately above the aortic valve and ends at the ascending aorta, at an imaginary line called the sinotubular junction (STJ).

The aortic root is actually not perfectly tubular. It is made up of three small bulges called sinuses, corresponding to the three leaflets of the aortic valve. From two of these sinuses, the two main coronary arteries originate to supply the heart muscle.

Diseases that cause dilatation (bulging) of the ascending aorta sometimes pass down the sinotubular junction into the aortic root. Sometimes dilatation of the aortic root causes the aortic valve to leak, even if the valve leaflets are not diseased themselves.

When the ascending aorta becomes larger than 5 cm in diameter, surgery is usually recommended to prevent the severe complications that could arise if it is left untreated.

In an aortic root repair, the surgeon replaces the damaged vessel wall with a synthetic tube, made of one of two durable materials called Dacron® or Gore-Tex®. If the dilatation of the ascending aorta has caused the STJ to enlarge, replacement of the ascending aorta can be enough to restore the shape of the aortic root. However, if the aortic root is itself diseased, it should also be replaced.

Aortic Valve–Sparing Root Replacement

Sometimes the aortic root is dilated, but the aortic valve leaflets remain healthy. In this situation, an aortic valve–sparing root replacement can be performed.

In this procedure, the surgeon replaces the aortic root to maintain the shape necessary for normal valve function, but preserves the natural aortic valve. This is usually enough to treat most aortic valve leaks that are not due to a disease in the valve itself.

Learn about other treatments for aortic disease:

For more information about the Methodist Aortic Network or to schedule an appointment, please call 713-441-5200 or complete our online contact us form.