Ascending aorta graft, with cardiopulmonary bypass with valve suspension, with coronary reconstruction and valve-sparing aortic root remodeling (eg, David Procedure, Yacoub Procedure)
CPT4 code
Name of the Procedure:
Ascending aorta graft, with cardiopulmonary bypass with valve suspension, with coronary reconstruction and valve-sparing aortic root remodeling (e.g., David Procedure, Yacoub Procedure).
Summary
This surgical procedure repairs the ascending aorta and aortic valve, aiming to preserve the patient's native valve while reconstructing the aortic root and coronary arteries. It's often combined with the use of a graft and requires the use of a heart-lung machine (cardiopulmonary bypass).
Purpose
This procedure addresses conditions affecting the ascending aorta and aortic valve, such as aneurysms or dissections. The goal is to replace the damaged segment of the aorta, preserve the patient's natural valve to avoid the need for a mechanical valve, and ensure normal function of the coronary arteries.
Indications
- Aortic aneurysm
- Aortic dissection
- Connective tissue disorders (e.g., Marfan Syndrome)
- Severe aortic valve regurgitation
- Patients who wish to avoid lifetime anticoagulation therapy, which is required with mechanical valve replacement
Preparation
- Fasting for at least 12 hours before surgery
- Adjusting or stopping certain medications (e.g., anticoagulants, antiplatelets)
- Pre-surgical diagnostic tests including blood tests, echocardiogram, and possibly a CT or MRI scan of the aorta
- Admission to the hospital a day before surgery for final assessments
Procedure Description
- The patient is given general anesthesia to be completely asleep and free of pain.
- An incision is made in the chest to access the heart and aorta.
- The heart is connected to a heart-lung machine (cardiopulmonary bypass) to maintain circulation and oxygenation.
- The damaged section of the ascending aorta is removed and replaced with a synthetic graft.
- Valve suspension techniques are used to support and preserve the aortic valve.
- Coronary reconstruction is performed to ensure the coronary arteries are reattached to the new root.
- The heart is gradually weaned off the heart-lung machine, and the surgery site is closed.
Duration
The procedure typically takes 4 to 6 hours, but this can vary based on complexity.
Setting
The procedure is performed in a hospital operating room equipped for cardiac surgery.
Personnel
- Cardiothoracic surgeon
- Cardiac anesthesiologist
- Surgical nurses
- Perfusionist (operates the heart-lung machine)
- Surgical assistants
Risks and Complications
- Bleeding
- Infection
- Stroke
- Heart attack
- Aortic valve dysfunction
- Complications related to anesthesia
- Need for a permanent pacemaker
- Mortality, which is low but possible
Benefits
- Resolves or significantly reduces the risk of aortic rupture or dissection
- Preserves the patient's natural valve, avoiding the need for anticoagulation therapy
- Improved heart function and quality of life
- Long-term durability of the aortic repair
Recovery
- Hospital stay of 5 to 10 days
- Initial intensive care unit (ICU) recovery for close monitoring
- Gradual return to light activities over 4 to 6 weeks
- Full recovery can take up to 3 to 6 months
- Regular follow-up appointments for monitoring and progress assessment
Alternatives
- Traditional aortic valve replacement with mechanical or bioprosthetic valve
- Endovascular aneurysm repair (less invasive but not suitable for all patients)
- Lifelong medication management and monitoring (not curative but palliative)
Patient Experience
- Patients will be under general anesthesia during the procedure and will not feel anything.
- Post-surgery, pain will be managed with medications.
- Expect some pain and discomfort in the chest area, fatigue, and limited physical capacity initially.
- Emotional and psychological support might be beneficial during recovery.
Pain management strategies, such as prescribed painkillers and physiotherapy, will help comfort the patient through the recovery process.