Aortic Hemiarch and Valve Replacement for Severe Aortic Stenosis with Ascending Aortic Ectasia
Adeel Ahmad, MD; Peter A. Collings, MD; Kirill Zakharov, DO
University of Michigan Health-Sparrow

Severe aortic valvular stenosis is a prevalent condition with potentially fatal consequences. Presenting symptoms may include dyspnea with angina/chest pains that can be significantly lifestyle limiting. Early detection and treatment are paramount to effective management, as untreated severe aortic stenosis has a five-year mortality of 50–70%. Treatment options range from the minimally invasive transcatheter approach to open heart surgery. Each strategy is tailored to the respective patient’s presentation, with considerations for cardiac anatomy, comorbidities, and patient frailty. When concomitant aortopathy is present, an open approach allows for definitive management of both conditions.

Aortic ectasia is an abnormal dilation of the ascending aorta that, while itself is not as serious, can be a precursor to aortic aneurysm or dissection. In patients undergoing surgical aortic valve replacement, a composite replacement strategy can also address concomitant aortic ectasia by incorporating the new valve into an aortic graft segment as a single implant.