Ascending Aorta Replacement/Repair

Aortic Dissection and Aortic Aneurism

The aorta is the largest blood vessel in the body with a diameter of approximately 3cm. Its primary function is to supply blood to all organs of the body. The aorta divides into the thoracic aorta (or thoracic part of the aorta) and the abdominal aorta (or abdominal part of the aorta). The thoracic aorta immerges from the left ventricle immediately after the aortal valve, and climbs towards the head, from where it branches out and supplies blood to the arteries of the neck and hands. It then descends towards the stomach and branches out to the abdominal organs and later to the arteries of the lower limbs.

There are several diseases that can affect the aorta, the main ones being aortic aneurism and aortic dissection.

An aortic aneurysm is a general term for any swelling or dilation of the aorta or any part of the aorta. The cause for the dilation or swelling is not always clear, but the high risk factors can include: untreated prolonged high blood pressure, congenital diseases that injure the structure of the artery wall, damage to the artery wall due to atherosclerosis and other factors such as diabetes and smoking, etc. In cases where the condition is not diagnosed early enough, the aorta could continue to dilate up to the point of a partial or full tear (dissecting aneurism), which poses an immediate life risk.

Aortic dissection may be caused as the result of severe injury or a fall from a considerable height, which poses an immediate danger to life if not treated immediately.

Following the diagnosis of an aneurism, surgical intervention and its timing would be considered. Surgical treatment for an aortic dissection or aneurism involves the replacement of the dilated section of the aorta with a Dacron-based graft (a synthetic tube made from Dacron), which is an inert material that does not affect the body and cause rejection, thereby negating the necessity of anticoagulation drugs.

The Procedure

The procedure is performed under a general anesthetic. During the operation the patient’s heart will be connected to a heart-lung machine, while the heart will be stopped throughout the entire procedure. The heart-lung machine replaces the heart’s function as a pump, as well as the lung’s capacity to oxygenate, thereby allowing the body to function normally.

During surgery the diseased part is cut away and replaced by a dacron graft. Should it also be necessary to replace the part of the aorta that leads to the brain, the patient’s body temperature has to be lowered to about 18-25°Celsius in order to lower the metabolism of the brain, and then the diseased part can be safely replaced. If necessary, during this phase, the brain can receive blood via other methods.

Following the completion of this stage, the patient’s body temperature is returned to normal, the heart-lung machine is turned off gradually and the chest area is closed.

What should be expected immediately following surgery?

Immediately following surgery the ventilated and sedated patient is transferred to the intensive care unit. During the first few days and in accord with the type of surgery, the patient will be gradually ‘weaned off ‘the ventilating machine. Once the patient has been stabilized, he/she will be transferred to a cardiac surgery ward for further care, and from there to one of the recovery wards of his/her choice and the approval of the HMO with whom he/she is insured.

A patient who arrives for treatment at an early stage of the diagnosis before it is too late to intervene surgically, can expect to return to a regular life style, including full physical exercise, sports, trips abroad and a normal way of life. The patient will be placed under long-term follow-up by the Cardioheal cardiologists, and will be able to schedule private consultations whenever necessary.

To coordinate a private consultation or operation – please fill out the contact form.

Are there any risks involved in undergoing aortic surgery?

Much like any invasive surgical procedure, bypass surgery is not without risk and complications, and it is important to be aware of this prior to making any decision to undergo surgery. In order to reduce those possible risks and complications, it is highly advisable to provide the surgeon and anesthesiologist with all your personal and medical history so that they can recommend the best treatment compatible with your specific medical background.

Any elective surgery (i.e. non-emergency surgery) is considered a relatively safe procedure, which has a relatively very low mortality rate (about 1%), as well as low complication risks. However, patients suffering from left ventricular systolic dysfunction, patients who have undergone a myocardial infarction resulting in an impaired heart muscle, patients suffering from cardiovascular diseases, or from chronic obstructive pulmonary disease, are considered to be at high risk for surgery. Risk from anesthesia is also relatively low.

Anesthesia & sedation

Aortic surgical procedures are performed under general anesthesia. This allows patients to undergo the entire procedure without the distress and pain they would otherwise experience. An anesthesiologist monitors your medical condition at all times to ensure you are in a state of deep sleep, that your muscles are completely relaxed and that you are in a state of total lack of awareness. Anesthesia is generally administered by an intravenous injection. Moments later the patient will fall into a state of semi-consciousness followed by drowsing into a deep sleep. After the surgical part of the operation is completed the anesthesiologist wakes the patient up by halting the administration of the anesthetics.

Once the patient is awake, he/she is transferred to the recovery ward in order to insure a safe and monitored recovery period.

Important information needed prior to surgery

In preparation for aortic surgery the patient must undergo a complete blood count, which includes the following: a biochemical analysis, electrolyte, liver function and blood clotting testing. An ECG and chest x-ray will also be performed. Furthermore, the patient will also need to have in his possession all the cardiac imaging tests that were performed, such as the diagnostic cardiac catheterization/virtual catheterization, cardiac CT, cardiac stress test etc. It is important for the patient to prepare an entire medical portfolio in order to be able to share his/her entire medical history with the surgeon and the anesthesiologist. It is especially important that the medical team be informed of prior surgical procedures and hospital admissions, chronic ailments, prescription drugs, diet supplements and allergies. Patients who suffer from secondary ailments are required to a consult with their individual specialists (e.g. internist, gynecologist, dermatologist) prior to undergoing surgery. One week prior to surgery and in accord with the surgeon’s recommendation), the patient should stop taking anticoagulation drugs such as Coumadin. It is important to confer with your family physician or your surgeon regarding substitutes. On the day of the operation, from 6 hours prior to surgery, the patient must be on a complete fast, including water intake. Before surgery, dentures, jewelry and personal items of clothing will be removed by a staff member, and it is advised to refrain from smoking. Should the operating site include bodily hair, this will be shaved off by a hospital staff member. It is advised to shower afterwards. Moments before the surgery, the patient will be hooked up to an infusion into which the anesthesiologist will introduce sedatives that will assist in relieving sensations of anxiety and stress.

Recuperation and recovery from aortic surgery

After a short stay in an intensive care unit, the patient will be transferred to a cardiac surgery ward where he/she will receive continued treatment from the medical and nursing staff. This will include general care and continuous heart monitoring by an ECG monitor connected to the body. A few hours later the patient will be assisted in getting off the bed in order to sit in an armchair. It is important to take into consideration that recovery is a gradual and prolonged process that takes 3 to 4 months.

During the first days after hospital discharge most patients feel weak due to the trauma of the surgery. It is recommended to increase activity levels gradually: start off by doing small tasks that require no physical effort or strain, and gradually pace yourself up in accordance with your general feeling.

About two weeks after surgery an appointment will be scheduled with the patient in order to review current status with one of Cardioheal’s doctors. At this time, it is important to inform the doctor of any new sensations or medical conditions that have arisen and update him about your general current state of health. If a patient has a fever over 38° C, or if he/she suffers from chest pain or any other alarming symptom, the surgeon or nurse on call must be informed immediately and without delay. It is recommended that the patient should not engage in any heavy lifting or strained physical exercise during the first 6 to 8 weeks following surgery. Should the patient suffer from dizziness or fatigue, it is also recommended to abstain from driving until these sensations pass.

Joining a cardiac rehabilitation program is also recommended and might assist and improve the recovery process. The initial rehabilitation period is generally provided at hotels or designated centers, and later at community clinics or hospitals. A rehabilitation period is highly recommended since it provides education and guidance in healthy nutrition, a custom-made exercise plan, and a general individual care and monitored program.

Duration of surgery and hospital stay

Duration of surgery and the hospital stay are individual in nature and depend upon the type of surgery and the medical condition of the patient. Generally speaking, surgery can last from 3- 6 hours, including the anesthesia, while hospital stay is about 5 days, but can be longer in certain cases.

To coordinate a private consultation or operation – please fill out the contact form.