Who Needs Ascending Aortic Aneurysm Repair
If you have a ruptured or dissected aneurysm in your ascending aorta, you have whats called Type A dissection, and you need surgery. Its an emergency surgery that can save your life.
You might also need surgery if you have an aneurysm thats at risk of rupture or dissection. Your provider will check your aneurysm once or twice a year using imaging tests. Sometimes an aneurysm thats very small or stable in size doesnt need treatment for a while. But if the aneurysm is large or shows signs of rapid growth, youll need surgery to prevent rupture or dissection.
Your provider will recommend surgery if the risks of delaying treatment outweigh the risks of surgery.
Most thoracic aortic aneurysms occur in the ascending aorta. Less often, they occur in the descending aorta or aortic arch.
Open Abdominal Or Open Chest Repair
This is the most common type of surgery to repair an aortic aneurysm, but itâs the most invasive, meaning that your doctor will go into your body to do it. Your surgeon replaces the weakened section of your aorta with a tube, or âgraft,â made of a special fabric.
First, youâll get general anesthesia. That means that you wonât be awake for the procedure.
Then your surgeon will make a cut either in your belly or chest, depending on where your aneurysm is located.
Next, the surgeon will restrict blood flow above and below the aneurysm using clamps. If the aneurysm is located just above the heart, a heart-lung machine will keep you breathing.
The surgeon will then remove the section of your aorta that is bulging and replace it with the fabric graft. The graft will allow blood to flow through the aorta without making it swell. Finally, the clamps will be removed to allow the blood to start flowing again.
The entire procedure can take anywhere from 2 to 6 hours and you may have to stay in the hospital for up to a week to recover. You should be able to get back to your normal activities in about a month.
Life after open chest repair. You’ll need to take aspirin for the first 6 weeks following surgery to prevent blood clots from forming. Your doctor will also likely put you on medicines called diuretics, or âwater pills,â to prevent fluids from building up.
Your chest may also feel sore and you may be given a breathing device to help you breathe more easily.
Sample And Data Collection
We included all patients who underwent elective replacement of an ascending aortic aneurysm at our institution between 2000 and 2019. Concomitant aortic valve or coronary surgeries were allowed. Aortic valve-sparing, Bentall-Bonno procedures and all surgeries on the aortic root or the aortic arch were included if the ascending aorta was also replaced.
Patients were excluded if they underwent a previous surgery on the ascending aorta or the aortic root. Patients with acute aortic syndrome, chronic dissections, pseudoaneurysms or those who required concomitant mitral or tricuspid valve surgery were also excluded.
All data relating to the pre-, intra-, and postoperative periods were collected retrospectively from a digital database completed prospectively by the patients surgeon. The postoperative period was taken as the first 30 days of follow-up, or until the date of hospital discharge if this was beyond 30 days.
Data on death during follow-up were collected by one of the researchers who analysed the information in the medical records from all the health centres and hospitals of our Region. All hospitals and health centres of our region are connected via intranet so, from our institution, we could investigate all medical records and health reports.
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What Are The Risks And Benefits Of Such Surgery
It is important to keep in mind that every medical choice involves a trade-off between risks and benefitswhether it is to undergo surgery, take medication, or even just carefully monitor a condition .
In the case of an aortic aneurysm, if you meet the criteria above , deciding whether surgery is advisable involves balancing the risks involved in any heart surgery against the increasing likelihood that your aneurysm may rupture, or burst. Your risk of dying if you suffer a ruptured aortic aneurysm is between 50% and 75%.
The risks involved in surgery are far lower. A given patient’s risk will vary, depending on such factors as age and overall health status, but the average mortality, or risk of death, from repair of an aortic aneurysm is about 5%. Surgery to repair an aneurysm is also associated with a 3% to 5% risk of a blood clot that causes a serious stroke. And any surgical procedure involves a very small risk of other complications, such as infection.
Patients who smoke can reduce their risk of complications if they stop smoking at least 2 to 4 weeks before their surgery .
The benefits of a successful repair are considerable. The overwhelming majority of patients who undergo repair of a major aortic aneurysm, once they recover, feel better than they did before the operation, are able to breathe far better, and are able to resume any activities they wish to engage in.
What Can I Do To Prepare For My Recovery At Home
Preparing for surgery can be nerve-wracking. Devote some of that nervous energy to making your home comfortable for your return. Ask family and friends to help you. Some tips include:
- Set up a bed and living space on the first floor. Youll probably be able to use stairs. But its a good idea to limit any risks of falling as you heal.
- Stock up on food and personal supplies.
- Make meals ahead and freeze them.
- Store supplies in cupboards or spaces that dont require bending down low or reaching up high.
- Have an easy-to-reach place for your phone and charger.
If you live alone, ask someone to stay with you or spend time with you each day. You may also want to arrange for someone to bring groceries or other supplies.
If you dont have family or friends close by, ask your healthcare provider to recommend a caregiving service. Its important to accept help from others as you heal. The more help you have now, the quicker you will recover and regain your independence.
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How Are Aortic Aneurysms Treated
The treatment of aortic aneurysms varies based on the location, size, and other factors. Treatments may include:
Lifestyle changes. Smokers should quit smoking. Doctors may also advise patients to avoid weightlifting, lifting heavy objects, or strenuous exercise.
Monitoring. For people with small, asymptomatic aortic aneurysms, doctor may opt to monitor the aneurysm at regular intervals using ultrasound or CT scans. If the aneurysm grows large enough or causes symptoms, surgery or endovascular repair may be necessary.
Medications. People with high blood pressure, high blood cholesterol levels, and atherosclerosis may be given drugs to get these conditions under control. Medications may include beta blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers , statins, and aspirin. Some of these drugs may also slow the growth of aneurysms.
Surgery. Large aneurysms or those that cause symptoms are typically treated with surgery. Ruptured or dissected aneurysms may require immediate surgical intervention. Surgical procedures for treating aortic aneurysms include:
How Long Does It Take For An Aortic Aneurysm To Heal
Open chest surgery. Open-chest surgery to repair a thoracic aortic aneurysm usually involves removing the damaged part of the aorta and replacing it with a synthetic tube , which is stitched into place. It usually takes a month or more to fully recover from this procedure.
Are there any risks in having an aortic aneurysm repaired?
The risks of repairing a thoracic aneurysm depend on the extent of the repair required, the length of the surgery, and your general health. Your surgeon will discuss with you the possible risks and benefits of the procedure. In 2005, mortality for thoracic aortic procedures fell to 3.9% at the Cleveland Clinic.
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Can Endovascular Methods Be Used To Repair An Ascending Aortic Aneurysm
Thoracic endovascular aortic repair repairs aneurysms in your descending thoracic aorta. Thats the part of your aorta that extends from the aortic arch down to the diaphragm. But TEVAR is rarely used for your ascending aorta . These two parts of your aorta have differences in anatomy and blood pressure. TEVAR was designed for the descending aorta.
However, in rare emergency situations, TEVAR has been used for the ascending aorta. It can save people who had a dissection but are too medically fragile to survive traditional surgery.
Researchers are developing new devices specifically for the ascending aorta. This exciting research shows much promise. In the future, endovascular methods could repair ascending aortic aneurysms. For now, though, traditional open surgery remains the preferred method.
When Should An Ascending Aortic Aneurysm Be Repaired
The best timing for ascending aortic aneurysm repair depends on many factors. The most important is whether you have symptoms. Others include the aneurysms size and how fast its growing. Your body size and your particular medical conditions also play a role.
Symptoms of rupture or dissection
If you have chest pain, you might need emergency surgery. This could signal the aneurysm is about to rupture.
- Sudden, severe pain in your chest or upper back. It may feel like something is tearing or ripping inside you.
- Chest pain of any kind.
- Clammy, sweaty skin.
- Shortness of breath.
Aneurysm size
Aneurysm size is one of the key factors that determine when you need elective surgery. You may need surgery when the aneurysm diameter reaches:
- In general, 5.5 centimeters.
- For people with , 4.5 centimeters.
- For people with Loeys-Dietz syndrome, 4.0 centimeters.
Aneurysm growth rate
Youll need surgery soon if your aneurysm is growing quickly. Thats true even if the aneurysm is considered smaller . You need surgery if:
- The aneurysm is growing 1 centimeter per year or 0.5 centimeters per six months .
- The aneurysm is growing 0.5 centimeters per year for people with certain conditions. These include some connective tissue disorders, bicuspid aortic valve or chronic dissection.
Individual factors
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What Is The Survival Rate After Ascending Aortic Aneurysm Repair
Aortic aneurysm surgery has good outcomes when performed before a rupture or dissection. About 95% to 98% of people survive elective surgery. But thoracic aortic aneurysm ruptures and dissections are often fatal. About 1 in 5 people who have a rupture or dissection dont live long enough to have surgery. Those who have emergency surgery are less likely to survive than those undergoing elective surgery.
About 85% of people who have elective thoracic aortic aneurysm repair survive for at least five years. That number drops to 37% for people who have emergency surgery after a rupture or dissection.
How Long Does It Take For The Sternum To Heal After Open Heart Surgery
It usually takes around two months for the sternum to heal fully.
Allowing the sternum to heal properly is one of the most crucial parts of your recovery. A physical therapist will teach you to move in ways that reduce pressure on your sternum. For example, youll need to keep your arms close to your body, as if youre moving inside of a tube.
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What Is The Aorta
The aorta is the main artery that carries blood away from your heart to the rest of your body. After the blood leaves the heart through the aortic valve, it travels through the aorta, making a cane-shaped curve that connects with other major arteries to deliver oxygen-rich blood to the brain, muscles, and other cells. When a problem occurs with the aorta, the heart and the entire bodys blood supply can be in jeopardy.
How Is Yale Medicine Unique In Its Care Of Aortic Aneurysm
At Yale, patients with thoracic aortic aneurysms are offered comprehensive care by expert surgeons and specialists, says Roland Assi, MD, MMS. Our patients have access to cutting-edge expertise and technological advances tailored to their condition, making surgery extremely safe and effective. Patients are offered genetic testing and have access to lifelong aortic surveillance programs, in addition to screening and counselingincluding for family members of affected patients.
The Yale Center for Advanced Thoracic Aortic Disease at Yale New Haven Hospitals Aortic Institute, part of the hospitals Heart and Vascular Center, is one of the largest centers in the world for patients with aortic aneurysm. Our specialists often manage the most complex cases.
Our researchers have impacted the way aneurysms are diagnosed and treated. A key component has been the development of a database of thousands of patients, one of the largest organized databases of its kind in the world. The database allows researchers to see patterns in patient populations. It has also helped to clarify such information as the size of aortic aneurysm that should be treated surgically, and to identify triggers of aortic dissection, such as extreme physical exertion or intense emotional experiences.
Written by Jeremy Ledger. Last medically reviewed by Prashanth Vallabhajosyula, MD, MS, and Roland Assi, MD, MMS, in March 2022.
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Aortic Aneurysm Surgery Recovery
Right after aortic aneurysm surgery, youll stay on the breathing machine for a short time. Well remove you from the machine as soon as possible.
Youll spend a few days in the hospital to recover. Usually, its about a week. The first couple of days will be in the intensive care unit . There we can watch you closely in case you have any complications from the surgery.
Complications after aneurysm surgery may include:
- Bleeding
What Is Thoracic Aortic Aneurysm Surgery
Thoracic aortic aneurysm surgery is a treatment for a bulge in the part of your aorta that runs through your chest . Your aorta is the large artery that carries blood from your heart throughout the rest of your body. It starts at your heart and extends through your chest and abdomen before it ends at your pelvis.
Aneurysms occur when there is a weak spot in one of your arteries. This weakening can lead to ballooning or expansion in that section of your artery. Thoracic aortic aneurysms are rare, affecting only about 1 in every 10,000 people.
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What Are The Risks And Complications Of Ascending Aortic Aneurysm Repair
Ascending aortic aneurysm repair is major surgery. Like any major surgery, it carries risks and complications. These include:
- Bleeding.
- Infection in the lungs, urinary tract or belly.
- Kidney failure.
- Lung disease.
- History of a stroke.
People over age 65 also face a higher risk of complications. Risks can vary based on the person. Talk with your provider about your individual risks and how to manage them.
Caring For Your Incision
Your incision is the area on the front of your chest that was cut open for surgery. Now its closed, but its still a wound. It needs special care as you recover. Your provider will tell you how to care for it. Youll likely need to change the dressing every day. Only remove the dressing to take a shower if your provider says its OK.
Sneezing or coughing might feel uncomfortable as your incision heals. To ease any pain, hug a pillow against your incision when you sneeze or cough.
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What Happens During Ascending Aortic Aneurysm Repair
Your surgeon will replace the weakened part of your aorta with a graft . If other parts of your aorta are damaged, like the aortic root or aortic arch, your surgeon can fix those parts at the same time. Your surgeon may also replace your aortic valve if needed. The extent of surgery depends on your aortas condition as well as your medical history and family history.
Once youre moved to the operating room, your care team will help you feel comfortable and relaxed. Youll be given general anesthesia that puts you to sleep during the surgery. During parts of your surgery, youll be on a heart-lung machine . Your care team may also use deep hypothermic circulatory arrest to stop your blood circulation.
Your surgery will include the following steps:
This surgery usually takes three to four hours. The time can vary based on how many issues need to be fixed.
How Long Does Sternotomy Pain Last
Your first three to four days after a sternotomy are the most painful. You may feel sore for up to a month, but pain lessens significantly after the first week.
We can give you intravenous or oral medications for pain while youre in the hospital. At home, you can usually manage the pain with over-the-counter medication such as acetaminophen.
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Open Aortic Aneurysm Surgery: What To Expect
This surgery repairs your aortic aneurysm using a special tube made of fabric and metal called a stent-graft. The tube replaces the aortic aneurysm and functions as the aorta. It relieves pressure on the aneurysm to keep it from rupturing.
We put the tube in place by:
- Starting with a cut on your chest or abdomen
- Opening the chest or abdomen to get to the aorta
- Putting clamps on the aorta above and below the aneurysm to stop blood flow temporarily
- Opening the section of aorta with the aneurysm
- Attaching the graft to the healthy part of the aorta
- Restarting blood flow
- Closing your chest or abdomen