Thoracic Aortic Aneurysm Repair
Thoracic Aortic Aneurysm Repair
What is it?
Thoracic aortic aneurysm repair involves the removal of an enlarged portion of the aorta replaced by a woven or knitted Dacron graft to continue uninterrupted blood flow through the aorta and all branch vessels.
How does it work?
Surgeons will have to perform open heart surgery to replace the weakened section of the vessel with an artificial tube, called a graft.
Reasons for Thoracic Aortic Aneurysm Repair
Surgery to repair an aortic aneurysm depends on the size and location of the aneurysm and the patients overall health. Aortic aneurysms in the upper chest (the ascending aorta) are usually operated on right away. Aneurysms in the lower chest and the area below the stomach (the descending thoracic and abdominal parts of the aorta) may not be as life threatening and are watched for varying periods, depending on their size. If they become large in diameter, continue to grow, or begin to cause symptoms, surgery may be performed to stop the aneurysm from bursting.
What to expect
The surgery can take anywhere from two to four hours. A hospital stay is required. Five to seven days is the usual hospital stay with the first one to two days being in the Intensive Care Unit (ICU).
Most patients are admitted to the hospital the day before surgery or, in some cases, on the morning of surgery. After being admitted to the hospital, the area to be operated on will be washed, scrubbed with antiseptic, and, if needed, shaved.
A mild tranquilizer, to relax the patient, will be given before entering the operating room. Small metal disks (electrodes) will be attached to the chest. These electrodes are connected to an electrocardiogram machine, which will monitor the heart's rhythm and electrical activity. The patient will then receive a local anesthetic to numb the area where a plastic tube (line) will be inserted in an artery in your wrist. An intravenous (IV) line will be inserted in the vein. The IV line will be used to give the anesthesia during the operation to make the patient sleep during the operation.
After the patient is completely asleep, a tube (ventilator) will be inserted down the windpipe and connected to a machine (respirator), which will take over breathing. Another tube will be inserted through the nose and down the throat, into the stomach. This tube will stop liquid and air from collecting in the stomach, so you the patient will not feel sick and bloated after surgery. A thin tube (catheter) will be inserted into the bladder to collect any urine produced during the operation.
A heart-lung machine is used if the aneurysm is located in the ascending aorta just above the heart. Before being hooked up to this machine, a blood-thinning medicine (anticoagulant) will be given to prevent your blood from clotting. Once the heart-lunch machine is hooked up, the heart is stopped and cooled.
When the operation begins, the surgeon will make a cut (called an incision) either in the abdomen or the chest. The incision depends on where the aneurysm is located. Surgeons will then place clamps on the artery above and below the aneurysm to stop blood flow to that part of the aorta. The heart and brain still get blood because other vessels take over.
The bulging section of the aorta is cut out. The surgeon will then replace the missing piece with a fabric tube called a graft. The clamps are then removed slowly to allow blood to flow through the vessel again.
After surgery, the remaining hospital stay is for testing and monitoring the patient’s condition. Once discharged, a patient will be advised to live a healthy lifestyle.