Minimally-Invasive Aortic Root Replacement: Is It Possible?
Written By: Adam Pick, Patient Advocate, Author & Website Founder
Medical Expert: Marko Boskovski, MD, Director of Ross Procedure and Aortic Valve Preservation, University of California San Francisco
Published: March 19, 2025
The use of minimally-invasive techniques for the treatment of aortic valve disease and related cardiac conditions including aortic aneurysm, atrial fibrillation and coronary artery disease is a key interest for patients in our community. For example, I recently received an interesting question from Evan. In his email, Evan wrote to me, “Hi Adam, Can the aortic root be replaced minimally invasively? Can an ascending aortic aneurysm be replaced minimally invasively?”
To answer Evan’s question, I was fortunate to interview Dr. Marko Boskovski, Assistant Professor of Cardiac Surgery and Director of the Ross Procedure and Aortic Valve Preserving Surgery at the University of California San Francisco (UCSF), during the recent Society of Thoracic Surgeons Conference.
Key Learnings About Minimally Invasive Aortic Root Replacement
Here are important insights shared by Dr. Boskovski during our discussion:
- Dr. Boskovski regularly performs minimally-invasive aortic root replacement surgery. So, the answer to Evan’s question above is “yes”. However, Dr. Boskovski stressed that getting a safe operation is of the utmost importance when considering any type of cardiac procedure. “I think the first and foremost priority is always patient safety,” stated Dr. Boskovski. “I think whatever it takes to perform a safe operation is what we do.”
- Dr. Boskovksi’s preferred approach to aortic root replacement is a minimally-invasive technique. Dr. Boskovski stated, “Our ‘go to’ approach for root replacement, such as a a Bentall procedure, ascending aortic replacement, even hemi-arch replacement, is through a minimally-invasive approach – through an upper hemi-sternotomy.”
Upper Hemi-Sternotomy
- It is important to note that there are some root replacement techniques in which a minimally-invasive approach is not recommended. A valve-sparing aortic root replacement is an example of a root replacement that Dr. Boskovski does not use a minimally-invasive approach. “There are certain root replacements that we do not do with a minimally-invasive approach,” stated Dr. Boskovski. “This is primarily if we’re trying to repair and preserve the patient’s own valve. For example, a valve sparing root replacement. Those procedures are done through a full incision because we feel that that is how we get the most optimal and long term, durable results.”
- Dr. Boskovski suggested that it is important for patient’s to retain their own aortic valve tissue, if possible, during operations including valve-sparing aortic root replacements. Patients may benefit from long-term durability and survival if the patient’s aortic valve tissue is preserved. “I think that there is a growing body of literature that having your own valve as opposed to a valve that’s made by man has advantages in terms of long-term durability and survival,” stated Dr. Boskovski. “This is especially true in younger patients. If possible, typically, when a valve is leaky, our preferred approach is to preserve and repair a patient’s own valve.”
Many Thanks to Dr. Boskovski and UCSF!
On behalf of Evan and all the patients in our community, thanks so much to Dr. Boskovski for taking the time to share his clinical experience and research with us. Also, many thanks to the entire University of California San Francisco (UCSF) team for taking such great care of heart valve patients.
Related links:
- See Dr. Boskovski’s Interactive Surgeon Profile
- Video: Towards A Living Aortic Valve with Dr. Boskovski
Keep on tickin!
Adam
P.S. For the deaf and hard-of-hearing members of our patient community, we have provided a written transcript of this video below.
Written by Adam Pick
- Patient & Website Founder
Video Transcript:
Adam Pick: Hi, everybody. It’s Adam with HeartValveSurgery.com and we are in Los Angeles, California at the Society of Thoracic Surgeons Conference. I am thrilled to be joined by Dr. Marko Boskovski, who is a leading aortic valve surgeon at the University of California, San Francisco. Dr. Boskovsky, it is great to see you here at STS and thanks for being with me today.
Dr. Marko Boskovski: Thank you for having me. It’s a pleasure.
Adam Pick: Dr. Boskovski we’re getting questions from patients all over the world and this one comes right in your specialty. It’s from Evan and he asks, “Can the aortic root be replaced minimally invasively? Can an ascending aortic aneurysm be replaced minimally invasively?”
Dr. Marko Boskovski: That’s a great question. And the short answer is, yes, it can. But, of course, the answer is a little more nuanced.
I think the first and foremost priority is always patient safety. I think whatever it takes to perform a safe operation is what we do. Sometimes that cannot be done minimally invasively but oftentimes it can.
As a matter of fact, our “go to” approach for root replacement, such as a a Bentall procedure, ascending aortic replacement, even hemiarch replacement, is through a minimally invasive approach – through an upper hemi-sternotomy. There are certain root replacements that we do not do with a minimally invasive approach.
This is primarily if we’re trying to repair and preserve the patient’s own valve. For example, a valve sparing root replacement. Those procedures are done through a full incision because we feel that that is how we get the most optimal and long term, durable results.
Adam Pick: Follow-up question for you Dr. Boskovski. You mentioned the idea of preserving the patient’s own valve tissue in a valve-sparing procedure for patients who may not be aware of why that’s important. What are the advantages to keeping your own aortic valve tissue?
Dr. Marko Boskovski: That is a very important question. I think that there is a growing body of literature that having your own valve as opposed to a valve that’s made by man has advantages in terms of long term durability and survival.
So, and this is especially true in younger patients. If possible, typically, when a valve is leaky, our “go to” approach is to preserve and repair a patient’s own valve.
Adam Pick: Evan, I hope that helped you. I know it helped me and Dr. Boskovski on behalf of all the patients at HeartValveSurgery.com, patients all over the world, thanks so much for what you and your team are doing at the University of California in San Francisco. Thanks for being with me today.
Dr. Marko Boskovski: Thank you for having me.
