Complex Aortic Surgery
Complex aortic surgery encompasses a range of operations on the aorta within the chest from its origin at the outlet of the left heart to its entry into the abdomen through the diaphragm. They are mostly performed for enlargements or aneurysms of the aorta or tears in the aortic wall called aortic “dissection”.
Aortic Root Surgery
- During aortic root operations, the aortic valve may be repaired or replaced, depending on the type of disease affecting it (enlargement, infection). The aorta at the outlet of the left heart, supporting the aortic valve is also replaced and this involved re-implanting the heart (coronary) arteries as they arise from this part of the aorta. Aortic root replacement options include tissue and mechanical valves within a synthetic tube graft and the Ross procedure
Other Aortic Surgery
- Aortic Aneurysm Surgery – Enlargements of the aorta in the chest known as thoracic aortic aneurysms require surgical repair once the aorta is enlarged more than 5cm in diameter. This involves removing the enlarged part of the aorta that contains the aneurysm and replacing it with a synthetic graft. This requires general anesthesia, open-chest surgery, use of the heart-lung machine, and a hospital stay of seven to ten days or more. If the aneurysm involves important branches of the aorta, these vessels may be repaired or bypassed
- Aortic Dissection Surgery – An aortic dissection is a tear in the wall of the aorta that allows blood to leak between the layers of the wall of the aorta. This condition is life-threatening and may also affect blood flow to the brain, heart and other vital organs. Emergency surgery is required due to the risk of rupture and life-threatening bleeding in addition to poor blood supply to various organs. The torn part of the aorta is replaced with a synthetic graft. Sometime the aortic valve must also be replaced as the tear disrupts its supporting mechanism.
- Endovascular Stent Surgery – Thoracic aortic aneurysms can also be treated with a minimally-invasive approach called endovascular stent-graft repair, depending on the location of the aneurysm. In this approach, a catheter is used to insert and guide a stent-graft (a polyester tube covered by a tubular metal web) into the aorta to the site of the aneurysm. The procedure is performed using a small incision in the groin and inserting the stent-graft into the femoral artery (which descends directly from the aorta). Using fluoroscopy (a continuous x-ray technique) and transesophageal echocardiography, the stent-graft is guided through the aorta to the aneurysm. With the stent-graft in place, blood flows through the stent-graft instead of through the aneurysm, eliminating the risk of rupture
- Hybrid Surgery – is available for more complex aortic arch surgery in specific cases and is a combined procedure performed with vascular and cardiothoracic surgeons.
Before the procedure:
- Eat and sleep well before surgery
- Stop smoking
- Stop taking herbal supplements
- Do not eat or drink anything twelve hours before your surgery
- Tell Dr Orr all the medications you are taking including non-prescription drugs and vitamins. Ask if you should stop taking any of these medications before surgery
- Tell your medical team if you are taking aspirin or blood thinners
- Tell your medical team about any food or medicine allergies
- Report any illnesses or feeling of sickness
- Plan ahead. Arrange your home so you will be comfortable after surgery. Put common items within easy reach. Make sure phone numbers of family and friends and your medical team are easily accessible
- Arrange for someone to take you to the hospital and drive you home
- Ask someone to stay with you after your surgery if you live alone
During the procedure:
- You will be under general anaesthesia for the duration of the surgery and several hours afterward. Your breathing will be supported by a tube in your airway and a ventilator
- Several intravenous catheters, or IVs, will be placed in your arms to provide fluids and medication during and after surgery. Another catheter will be placed in the side of your neck and a monitoring line will be placed in an artery at your wrist to measure your blood pressure and take blood samples
- During the operation the heart-lung machine is used to support your circulation while your cardiac surgeon uses specialized techniques to repair the aorta. Tube grafts made of a material called dacron are used to reconstruct the aorta
After the procedure:
- Aortic surgery usually takes 4 to 6 hours
- After the surgery is completed, the patients usually spend 2 to 4 days in the intensive care unit followed by 5 to 10 days on the post-operative cardiac ward
- You will feel tired and sometimes uncomfortable – this is normal. It takes time to regain your energy and appetite
- Keep your wound clean
- Some operations may require outpatient cardiac rehabilitation to help recovery
- Lifting and driving will be restricted for 6-8 weeks after the operation.