An innovative approach to aortic aneurysms provides an elegant solution

It killed Albert Einstein and Charles de Gaulle, Lucille Ball and John Ritter. And every year, nearly 200,000 more people die from an aortic aneurysm. It often has no symptoms and lies undetected, like a ticking time bomb waiting to go off. The only solution is open-heart surgery-and all the complications that entails.

Today at Sarasota Memorial, however, surgeons cut those complications in half for patients with aortic root aneurysms, using a new approach that is faster, safer, and less intrusive but just as effective, if not more: the Florida Sleeve.

"The Florida Sleeve is technically faster and simpler than other procedures available for valve repair,” says First Physicians Group Cardiovascular Surgeon Kristen Walker, MD, who brought the technique to SMH from the University of Florida where it was originally developed. "It gets the patient on and off the heart and lung machine much faster, which leads to faster recovery times and fewer complications."

What is an aortic root aneurysm?

Aorta

The aorta is the largest and strongest blood vessel in your body. That's because it's the artery connected directly to your heart, which is an incredibly strong muscle pumping gallons of freshly oxygenated blood through your body every day. The heart is so strong, in fact, that the aorta itself is forced to expand and contract as it absorbs the force of every heartbeat. At more than 100,000 beats a day, that's a lot of wear-and-tear.

Aneurysm

An aneurysm is a balloon-like bulge in the weakened wall of a blood vessel, such as the aorta, that can rupture with no warning. This can occur in both arteries and veins, and can be caused by age, uncontrolled blood pressure, and risk factors like smoking.

An aneurysm is a serious and life-threatening condition, even if some may cause no symptoms or present no immediate danger, as the potential complications include stroke, brain damage, and massive internal bleeding that can be fatal in moments. This is especially true of an aneurysm in the aorta.

Aortic Root

Experts divide the aorta into four sections:

• Aortic Root: this is the section that attaches directly to the heart. It contains the aortic valve and the sinuses, as well as connects to the left and right coronary arteries.
• Ascending Aorta: the section of aorta traveling upward from the heart and aortic root.
• Aortic Arch: The curved segment at the top, supplying blood to the arms, brain, head and neck, while bridging the ascending and descending aorta.
• Descending Aorta: the long vessel running down from the chest to the abdomen, supplying blood to lungs, windpipe, esophagus, stomach, spleen, spinal cord, back muscles and more.

That means an aortic root aneurysm is:

1. A life-threatening swelling,
2. Located in the most important blood vessel in your body,
3. Exactly where that blood vessel is most complex.

That's a serious problem. And a serious problem needs a serious solution.

The Florida Sleeve: Saving Lives & Saving Valves

For a long time, there were only two surgical solutions to an aortic root aneurysm: the David Procedure and the Ross Procedure.

• The David Procedure calls for disconnecting the coronary arteries and removing the weakened or diseased tissue from the aortic root but saving the aortic valve. A graft is used to replace the removed tissue and then the valve and coronary arteries are sown into that graft.
• The Ross Procedure calls for removal of the aortic root and its replacement with another blood vessel containing a similar valve. That structure is then replaced with a donated one.

Both are life-saving operations, but both are also highly laborious and complex. More importantly, every incision, graft, stitch, and replacement presents potential points of failure or complication. This is true of any surgical operation. The Ross and David procedures have many such points and in unforgiving locations.

Enter the Florida Sleeve, a homegrown innovation providing an elegant solution, brilliant in its simplicity.

How does it work?

Essentially, the Florida Sleeve is a protective graft placed around the aortic root and sewn up nice and snug, shoring up the weakened wall of the aneurysm and preventing it from worsening. At the same time, the "sleeves" are customized to each patient's heart structure, with the surgeon snipping holes in the graft to accommodate the coronary arteries, preserving the natural connections as opposed to cutting them away and sewing them back in place after.

Also, by preserving the aortic root, the Florida Sleeve approach also preserves the original aortic valve, which is a significant advantage for patients, who would otherwise rely on either mechanical valves, which require a lifetime on blood thinners, or donated valves, which require replacement every 10-15 years.

“No valve that we've made with technology is better than the valve you're born with,” says Dr. Walker, “so the goal is always valve-sparing operation, if possible.”

To hear more from Dr. Walker about aortic aneurysms and the Florida Sleeve, watch the HealthCasts video below.

 

 

Written by Sarasota Memorial copywriter Philip Lederer, MA, who crafts a variety of external communications for the healthcare system. SMH's in-house wordsmith, Lederer earned his Master's degree in Public Administration and Political Philosophy from Morehead State University, KY, and has renewed hope.