When evaluating patients with aortic aneurysms, the following concepts may be considered 'golden rules.' These tenets are based on years of surgical experience at this center, and are guiding principles in the aortic surgeon's decision-making process.
If a patient has an aneurysm of the aortic root, a primary question is whether the valve can be repaired, and if so, we then ask, "Should the valve be repaired?"
This crucial decision is determined by golden rule number one. This rule holds that repair must result in the valve lasting longer than any commercially available valve that could be used during a replacement. Most tissue or mechanical valves can be expected to last about 15 years, depending on the prosthesis and the patient's condition. If repairing the valve would potentially achieve a durable result, repair will be performed instead of replacement.
A second golden rule is that no leaking of the valve (aortic insufficiency) is acceptable. This means that after the procedure is performed, the expectation is a perfect result. If the valve appears to be less than perfect in any way, it is revised during the operation so that the patient leaves the operating room with a well functioning valve.
A third golden rule is that all diseased aortic tissue must be removed. There is no value in an inadequate operation. This means that whether the approach is open or hybrid, all affected tissue must be removed. If a stent graft is being used, then there must be no leakage at or through the stent.
Rule four: safety is the key to preventing strokes and bleeding. Good perfusion (blood flow) to the brain must be meticulously maintained throughout surgery.