Aortic Disease Treatments and Procedures

TAVR is a minimally invasive procedure for patients with aortic stenosis. Our surgeons insert a tissue valve inside the diseased valve. The replacement valve expands in place, where it immediately takes over valve function.

Patients recover quicker with TAVR than with an open, invasive procedure. The risk of postoperative infection is also lower. Find out more about TAVR.

Open aortic valve procedures require direct access to the heart. Procedures available to patients at the Frankel Cardiovascular Center include:

Aortic valve repair or replacement: If you have a leaking valve, repair allows you to keep your valve, which may improve long-term outcomes. If repair is not possible, the valve can be replaced with a mechanical or tissue valve.

Ross procedure: This is a complex procedure in which your diseased aortic valve is replaced with your pulmonary valve (one of the other four heart valves). A valve from a human donor or animal tissue is attached in place of the removed pulmonary valve. The Ross procedure is most often performed on younger patients. Read more about the Ross procedure.

Y-incision/rectangular patch aortic root enlargement: This procedure developed at the Frankel Cardiovascular Center offers excellent outcomes for people who need a new aortic valve. The cardiac surgeon enlarges the aortic root and inserts a prosthetic valve that is three to four valve sizes larger. The large valve results in improved blood flow, quality of life and long-term survival.

Prosthetic valves last about 8-10 years. Because the new valve is so large, you can have a minimally invasive TAVR procedure if you need to have the valve replaced again.

We offer minimally invasive procedures to fix areas of the aorta damaged by aortic aneurysm or dissection. Using a catheter (thin tube) inserted into an artery, surgeons fit a stent graft inside the affected area. Made of metal mesh covered by fabric, stent grafts provide reinforcement and long-lasting support.

Minimally invasive procedures target different parts of the aorta. Procedures include:

• Thoracic endovascular aortic repair (TEVAR): This procedure repairs aortic aneurysms and dissections that occur in the chest. Learn more about TEVAR.
• Endovascular aortic repair (EVAR) and fenestrated endovascular repair (FEVAR): Both procedures repair abdominal aorta aneurysms and dissections. EVAR uses standard stent grafts. FEVAR uses stent grafts with holes, or fenestrations, that are fitted so they line up with the arteries that branch off the aorta. The holes allow blood to continue to flow to these areas. FEVAR stent grafts can be customized based on a patient’s anatomy and the location of the aneurysm or dissection. See more about EVAR and FEVAR.

Our surgeons frequently perform some of the most challenging aortic procedures. In some cases, we have developed new techniques and refined existing ones to give patients the best possible treatment options. Examples of these leading-edge procedures include:

Aortic arch replacement: Aneurysms and dissections involving the arch can be challenging to repair because of the arteries that branch off to the head. Our team uses a technique that temporarily cools the body to suspend blood flow while preserving brain function and preventing stroke. The technique is called hypothermic circulatory arrest

David procedure (valve-sparing aortic root replacement): Sometimes, when an aneurysm or dissection occurs near the root, our surgeon replaces the root and, possibly, the ascending aorta with a graft. But the healthy aortic valve is reimplanted. Our surgeons spare your valve when possible because it is more resilient and resistant to infection. Also, by keeping your own valve, you won’t have to take blood thinners for the rest of your life.

Laser-assisted treatment in dissection: When dissections occur, they may block blood flow to the branching arteries. This is called malperfusion syndrome. Our specialists use a laser inserted through a catheter to make holes (fenestrations) in the blockage and restore blood flow. Our team can then repair the dissection. This procedure was developed at University of Michigan Health and is known worldwide. It greatly improves survival in patients with life-threatening dissections.

Repair of the descending thoracic aorta: Open repair of a thoracic aortic aneurysm (TAA) or thoracoabdominal aortic aneurysm (TAAA) is one the most complex operations surgeons do. The surgeon removes the damaged part of the aorta and replaces it with a graft. Repairs in the descending thoracic aorta can cause postoperative pain. Our surgeons use a special cryoablation procedure to freeze the nerves and reduce pain. This allows patients to go home without any narcotic pain medications.

Hybrid procedures combine open and minimally invasive procedures, allowing our surgeons to personalize treatments. They are especially useful when an aortic condition affects multiple areas. In this case, we can minimize the invasiveness of the overall surgery by treating one area with a catheter from a smaller opening elsewhere.