For as long as he can remember, Kyle Conway has known he’d need surgery one day to fix an aortic aneurysm — a condition associated with multiple congenital heart defects that were surgically repaired when he was just a preschooler. Thirty years later in Pittsburgh, he turned to experts at the UPMC Heart and Vascular Institute for a valve-sparing aortic root replacement (David procedure).
The Problem: Aortic Root Aneurysm
Kyle was just 4 years old when he had surgery to repair two serious congenital heart defects: coarctation of the aorta (a narrowing of the aorta) and bicuspid aortic valve (when the aortic valve has two leaflets instead of three).
Although he had a normal childhood growing up in northeast Ohio, Kyle was always monitored by cardiologists. They eventually detected a small aneurysm, a condition that can develop in patients born with those birth defects. Despite the diagnosis, Kyle went on to become a runner on his high school cross country team.
When he moved to Pittsburgh at age 26, Kyle quickly found a UPMC cardiologist to monitor the slow-growing aneurysm in the aortic root close to his heart. He also ran his first long-distance race — the Pittsburgh Marathon — to celebrate his life and victory over his heart defects.
Path to the UPMC Heart and Vascular Institute
“I always knew I eventually would need heart surgery,” says Kyle, a Bloomfield resident and an accountant at Carnegie Mellon University. “That’s why it was important to me to find a cardiologist to keep on top of things.” His search led him to UPMC cardiologist John Power, MD.
An aortic aneurysm is an abnormal dilation of the aorta, which is the body’s largest blood vessel. Kyle’s aneurysm developed in the aortic root, the section of the aorta closest to the heart that contains the aortic valve and the openings for the coronary arteries. Surgery is usually recommended when the aortic root dilation, or aneurysm, reaches 5-5.5 centimeters.
Dr. Power closely monitored Kyle’s aneurysm. When the aneurysm grew to over 5 centimeters in 2019, he referred the then 33-year-old to Ibrahim Sultan, MD, director of the UPMC Center for Thoracic Aortic Disease and a cardiothoracic surgeon with the UPMC Heart and Vascular Institute.
“I didn’t have any pain and I didn’t have any symptoms. I just knew the aneurysm was there because of the echocardiograms and the CT scans,” says Kyle. “I also knew I was in good hands, so I didn’t really worry about it. But it was always in the back of my mind.”
The Solution: Valve-Sparing Aortic Root Replacement
The aortic root houses the aortic valve, which allows blood to exit the heart into the aorta. When the heart pumps blood, the valve opens, then closes to prevent blood from flowing back in from the aorta.
When the aortic root becomes aneurysmal (also known as “dilated”), it pulls apart the leaflets of the aortic valve so that it can’t fully close. As a result, it can’t prevent blood from leaking backward into the heart, leading to what is called aortic regurgitation. This can cause life-threatening problems, including insufficient blood flow to the body’s organs, a dissected or ruptured aorta, and heart failure.
When Kyle saw Dr. Sultan, they discussed the timing, as well as the risks and benefits, of surgery including watchful waiting. They discussed specific advantages of preserving Kyle’s own aortic valve as is done in a valve-sparing root replacement which was the ideal therapy for him.
“Dr. Sultan explained everything to me in detail,” says Kyle. “He used computer models to show me where the aneurysm was located and what he needed to do. He also told me what my recovery would be like.”
After talking it over, Kyle and his wife, Kathleen, decided it was time to replace the aorta before it grew any larger. On Dec. 14, 2020, Dr. Sultan and his team performed a valve-sparing aortic root replacement at UPMC Shadyside.
The Results: A Lifetime Fix
Kyle spent five days in the hospital. Within days of returning home, he was walking around the block outside his Bloomfield home. Six weeks after surgery, he was “90%” recovered. He plans to return to running again this spring.
“I feel great. Everything went exactly the way Dr. Sultan described,” says Kyle.
“It’s a lifetime fix and I’m really happy it has been repaired. It’s a weight off of my shoulders.”
Kyle praised Dr. Sultan and his team for the care he received before and after surgery.
“Every time I’m there, they provide great information and answer all my questions. The testing is top-notch,” he says. “It’s great knowing you’re being treated by the best in the world.”
He returned to running again in the spring.
Kyle's treatment and results may not be representative of similar cases.