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"What is Aorta Root Carving and Enlargement?" Asks Ellie

Written By: Adam Pick, Patient Advocate & Author
Medical Expert: Dr. Marc Gerdisch, Chief of Cardiac Surgery at Franciscan Health
Published: January 8, 2025

In response to this post about patient outcomes for heart valve reoperations, I received a very interesting question from Ellie about aorta carving and enlargement. In her email, Ellie wrote to me, "Hi Adam - Six months after I had a surgical aortic valve replacement, my medical team told me that the new bovine valve does not fit well. I am also being told that I need a redo with a possible root enlargement to place a larger tissue valve. What should I know about aortic root carving and enlargement?"

Ellie asks a really important question for all patients to consider. To learn more, I reached out to Dr. Marc Gerdisch, the Chief of Cardiac Surgery at Franciscan Health. During his extraordinary career, Dr. Gerdisch has performed over 4,000 heart valve repair and replacement operations. In our community, Dr. Gerdisch has successfully treated over 125 patients.

Dr. Marc Gerdisch

About Aortic Root Enlargement

After I sent Ellie's question to Dr. Gerdisch, I was lucky to quickly receive the following response from Dr. Gerdisch.

First, Dr. Gerdisch provided an educational overview of aortic root carving and the patient benefits of aortic root enlargement. "Ellie is describing a root enlargement, which we commonly perform to ensure an appropriate size valve is implanted," stated Dr. Gerdisch. "When doing an enlargement, we cut down into the wall of the aortic root and then along the perimeter a bit in both directions, just beneath the annulus (the location where the leaflets attach) and sew a patch to create new space to accommodate the right size valve. In general, the larger the valve, the better the hemodynamic performance, and the longer the replacement valve will last. Also, in general, the larger the valve, the more suitable it will likely be for a valve-in-valve in the future (placing a TAVR inside the surgical bioprosthesis)"

Alternative Treatment Option: Aortic Root Replacement

Next, Dr. Gerdisch addressed an alternative to aortic root enlargement which is aortic root replacement.

According to Dr. Gerdisch, "Root replacement is the other method we use to implant a larger valve. For a root replacement, we remove the entire root of the aorta and separate the coronary arteries from the wall of the aortic root. Then, we replace the root with a synthetic aortic root (a Dacron graft) that has a valve built into the aortic graft. After the graft is positioned, we reattach the coronary arteries.

Aortic Root Enlargement vs. Replacement: Which Is Better?

Specific to determining the best approach for a patient similar to Ellie, Dr. Gerdisch stated, "As for which option - aortic root enlargement or aortic root replacement - is best for the patient, the choice is based on the particular patient anatomy, position of calcifications, and the quality of the aorta.

Many thanks to Ellie for her question and a special thanks goes out to Dr. Gerdisch for sharing his clinical experiences and research with our community!

Written by Adam Pick - Patient & Website Founder

Adam Pick is a heart valve patient and author of The Patient's Guide To Heart Valve Surgery. In 2006, Adam founded HeartValveSurgery.com to educate and empower patients. This award-winning website has helped over 10 million people fight heart valve disease. Adam has been featured by the American Heart Association and Medical News Today.

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