What is Aorta Surgery?

What is Aorta Surgery?

Aorta surgery fixes issues with your aorta the largest artery in your body. Your aorta, which connects to your heart, carries oxygen-rich blood from your heart to the rest of your body. It goes all the way from your heart into your belly area where it splits into the arteries that supply your legs.

When the walls of your aorta weaken, they stretch out and form an aneurysm. There are times when the inner part of an aorta tears. That’s a dissection. The enlarged or torn aorta can rupture and lead to life-threatening events.

When do you need aorta surgery?

Your provider will recommend surgery on an aneurysm if it’s larger than a certain set limit or if it’s growing faster than usual. The set limit balances the risk of the surgery with the complications and risks of the repair. When your aorta is enlarged close to your heart, the status of your heart valve that it’s attached to will also influence the decision of when to do aorta surgery.

You need aorta surgery before your aorta wall is in danger of breaking. Many diseases and conditions can cause your aorta to dilate (widen) or can cause aortic dissection (tear), increasing your risk for future life-threatening events. Conditions that can lead to aortic aneurysm and aortic dissection include:

  • Atherosclerosis (hardening of your arteries).
  • Hypertension (high blood pressure).
  • Connective tissue disorders (like Marfan Syndrome).
  • Injury.

There are multiple types of aortic aneurysms (weakened, bulging artery walls in your aorta). An aneurysm can develop anywhere along your aorta, such as:

  • In the part that runs through your abdomen (abdominal aortic aneurysms).
  • In your chest (thoracic aortic aneurysms). These can involve your aortic root (the section of the aorta that’s attached to your heart), ascending aorta, aortic arch or descending aorta.
  • In both your abdomen and chest (thoracoabdominal aortic aneurysms).

Aorta surgery also treats aortic dissection, or the separation of your aorta wall’s layers. Blood flows through a tear in the inner layer of your aorta. This can be a life-threatening condition.

How serious is aorta surgery?

Aorta surgery is serious because your aorta sends oxygen-rich blood from your heart to your whole body. Your body relies on a fully functional aorta.

Like many things in medicine, aorta operations tend to go better when a surgeon performs scheduled elective surgery instead of emergency surgery. And survival rates are much better when you have surgery on an aneurysm before it ruptures.

Procedure Details

How is aortic surgery done?

Depending on your situation, your provider can do aortic surgery by:

  • Splitting your breastbone (open-heart surgery).
  • Opening your abdomen or opening your chest and abdomen together, splitting your ribs (open aortic surgery).
  • Relining your artery with a stent graft by going through blood vessels in your groin (minimally invasive or endovascular method).

Endovascular means that your surgeon performs your operation inside your body without large open incisions. Through small incisions or punctures in your groin, your provider uses the catheters to guide a stent graft through the blood vessels to the site of your aneurysm.

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An endovascular stent graft is a tube made out of metal and covered with fabric (also called a scaffold) that reinforces the weak spot in your aorta. By sealing the area tightly with the artery above and below the aneurysm, the graft allows blood to pass through it without pushing on the aneurysm.

Advantages of endovascular repair of thoracic aneurysms include:

  • Shorter length of stay in the hospital.
  • Better option for people who aren’t candidates for open surgery, which has higher risks.
  • Shorter recovery time due to its less invasive nature.

What happens before aortic surgery?

Tell your provider about all of the medicines you take, even those without a prescription. They may ask you to stop taking some of them for a specific amount of time before surgery.

Go to any appointments that your provider requires, such as for an electrocardiogram (EKG), imaging or bloodwork. This gives them valuable information they’ll need for your surgery.

Ask someone to drive you to and from the hospital. You also may want someone to stay with you for the first few days after you get home from the hospital.

Ask your employer if you can receive disability coverage while you recover.

Get instructions about how to prepare, such as when to stop eating the night before surgery.

How long does aortic surgery take?

The time needed for aortic surgery depends on which procedure you’re having, among other factors. The larger the incision, the longer the procedure and the longer the recovery, both in the hospital and at home. Open aortic repairs can take four to eight hours and minimally invasive endovascular repairs can take two to four hours.

What happens during aorta surgery?

Your surgical procedure depends on what kind of problem you have with your aorta and which method your provider uses.

Surgery for aortic aneurysms

If you have an aneurysm, your surgeon will replace or strengthen the stretched part of your aorta. They use a synthetic fabric such as Dacron to replace or repair blood vessels.

Aneurysm in your ascending aorta: For an aneurysm in your ascending aorta (which goes up toward your head), your surgeon uses a tube graft to replace the damaged section. They get to it through a sternotomy, or cutting through your breastbone. They’ll also use this approach to operate on your aortic arch, a curved part that goes up toward your neck.

Depending on the location of your aneurysm, your surgeon will need to replace or repair your aortic valve and/or aortic root next to your valve.

Aneurysm in your descending thoracic aorta: If your aneurysm is in your descending thoracic aorta, which goes down your chest toward your belly, your provider repairs it by placing a stent graft through your groin arteries and positioning it across the aneurysm. This is a thoracic endovascular aortic repair. If a stent graft can’t fix the aneurysm, your provider can reach it through a cut between your ribs known as a thoracotomy.

Thoracoabdominal aortic aneurysm: Complex aortic procedures treat people with aneurysms that need replacement of their aorta from the aortic valve down to the aortic bifurcation (where the aorta separates into two).

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Surgeons can perform repairs that involve your thoracic and abdominal aorta (also called a thoracoabdominal aneurysm) through a single operation that uses combined incisions in your chest and mid-abdomen.

In the first stage, your surgeon replaces your aortic valve, ascending aorta and arch. They place a tubular-shaped “elephant trunk” graft that hangs in your descending aorta. They’ll use this later in the second stage as a proximal attachment.

The second stage entails thoracoabdominal aneurysm repair that surgeons traditionally do with one incision across your chest and abdomen to fix the aorta all the way down to the aortic bifurcation (to your legs). More recently, as part of the second stage, they deploy stents first in your thoracic descending aorta to make the thoracoabdominal component easier.

In cases where the aneurysm extends from the root to the descending thoracic aorta above your abdominal aorta and its branches to abdominal organs, the second stage involves only an endovascular approach. They deploy stents into the “elephant trunk” all the way down to the “normal” abdominal aorta.

In cases that involve the mid-descending thoracic aorta to the abdominal aorta at the level of the aortic bifurcation, providers use a single staged repair with one incision across your chest and abdomen.

Aneurysm in your abdominal aorta: If your aneurysm is in your abdominal aorta, your provider can use stent grafts placed from your groin arteries to cover the aneurysm and eliminate blood flow to it. Sometimes, for aneurysms that are too close to kidney arteries or gut arteries, they can use customized grafts that have openings (fenestrations) or small branches for fabric-covered stents that are placed into the kidney arteries or gut arteries.

If the aneurysm doesn’t meet the criteria for repair by a stent graft, then your surgeon will fix it by either making an incision from under your breastbone to your pubic bone or making an incision down your left side (retroperitoneal).

Aneurysm in your aortic root: David’s valve-sparing aortic root replacement method and its modifications repair aortic root aneurysms while preserving your aortic valve. They can use a bioprosthetic valve if your aortic valve isn’t usable.

Surgery for aortic dissection

If you have an aortic dissection or tear in your aortic root or ascending aorta, you’ll need emergency surgery. Your surgeon will cut through your breastbone (sternotomy). They’ll use a heart-lung machine to handle your breathing and blood circulation. They use a fabric graft to replace a damaged ascending aorta. They may also need to replace your aortic valve, aortic root or aortic arch.

If the dissection doesn’t involve your ascending aorta or aortic arch, your surgeon can treat it by placing a stent graft through your groin arteries and positioning it to cover the tear.

Surgery for aortoiliac occlusive disease

If you have a blockage in your aorta or iliac arteries from the buildup of cholesterol in your blood vessels, your surgeon opens your arteries with balloons and stents from your groin arteries. In some people, when the blockage is too severe, your surgeon reroutes (bypasses) your blood flow from your abdominal aorta to your femoral (groin) arteries through an incision from under your breastbone to your pubic bone.

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What happens after aorta surgery?

You’ll start out in the intensive care unit. You may wake up there and have a breathing tube in your throat. Your care team will remove it when you can breathe on your own.

When you’re able to, you’ll start walking a little bit.

You’ll move to a different room when you don’t need to be in the intensive care unit anymore.

You’ll talk with your provider about going home when you’ve met their criteria for discharge.

Risks / Benefits

What are the advantages of aorta surgery?

An aorta operation can save your life. It can prevent an aneurysm from rupturing.

What are the risks or complications of aorta surgery?

Complications vary depending on the type of aorta operation you have.

For aortic aneurysm and dissection repair, complications include:

  • Bleeding.
  • Stroke.
  • Heart attack.
  • Kidney failure.
  • Leg paralysis and ischemia.
  • Breathing issues.
  • Blood clots.
  • Bowel ischemia.

Recovery and Outlook

How long does it take to recover from aortic surgery?

After open aortic surgery for an aneurysm, people typically spend a week in the hospital. They also need two to three months to fully recover.

If you have minimally invasive surgery, you may only be in the hospital for one or two days and need two to three weeks to fully recover.

What is the survival rate of aortic surgery?

The survival rate for aortic surgery depends on the type of surgery and other factors. Aorta surgery survival rates are better for elective (preventive or scheduled) surgery than for emergency surgery.

For an abdominal aortic aneurysm, 99% of people survive both open and endovascular repair. But only 70% survive surgery after their aneurysm ruptures before repair.

Survival rates for ascending aorta and aortic arch aneurysms were 81% to 95% after one year. After eight to 10 years, they were 60% to 73%.

When to Call the Doctor

When should I see my healthcare provider?

Contact your healthcare provider if you have:

  • Redness, swelling or draining at your incision site.
  • A fever.
  • Chest pain.
  • Shortness of breath.

If you have an aortic aneurysm or dissection, you’ll need regular follow-ups with your provider. They’ll want to:

  • Check for complications.
  • Make sure your aorta isn’t developing new issues.
  • Order imaging of the aorta with CT or MRI scans.

Advancements in aortic surgery can provide multiple options for your surgeon. Talk with them about what type of surgery is best for your situation. The best option for you may not be the one that was best for someone you know who had a similar issue. Ask your provider questions about anything you don’t understand about your aortic surgery.


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