Aorta Surgery

Overview

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.

With a high volume of blood flowing through your aorta, its walls can get weak and stretched out. This is an aneurysm. Also, high blood pressure can push the layers of your aorta wall apart, which is an aortic dissection.

These issues compromise your aorta’s ability to send blood with oxygen to your body’s cells and tissues. In some cases, the damage is life-threatening.

When do you need aorta surgery?

Your provider will recommend surgery on an aneurysm if it’s growing about a half-inch in diameter a year. The timing of surgery for a slow-growing aneurysm varies. However, many surgeons operate when an aneurysm is 2 to 2.2 inches because dissections and ruptures are more likely at about 2.4 inches.

You need aortic surgery before your aorta wall is in danger of breaking. When your aorta wall gets too stretched out, that can lead to aortic dissection.

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 the arteries).
  • Hypertension (high blood pressure).
  • Genetic conditions (such as Marfan syndrome).
  • Connective tissue disorders.
  • Injury.

Aorta surgery treats 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 is a life-threatening condition.

People born with rare heart conditions like coarctation (narrowing) of the aorta or transposition (reversal) of the great arteries also need aorta surgery.

Others need surgery for a problem with their aortic valve.

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 they aren’t delayed too long. For example, survival rates are good when you have surgery on an aneurysm before it ruptures.

Procedure Details

How is aorta surgery done?

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

  • Splitting your breastbone (open-heart surgery).
  • Cutting between your ribs (thoracotomy).
  • Going through your blood vessels (minimally invasive or endovascular method).

Endovascular means that your surgeon performs your operation inside your body using thin, long tubes called catheters. Through small incisions in your groin, your provider uses the catheters to guide a stent graft through the blood vessels to the site of your aneurysm.

An endovascular stent graft is a small, wire mesh tube (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:

  • Generally less painful than open-heart surgery.
  • Lower risk of complications than traditional open-chest surgery because of smaller incisions.
  • Better option for people who aren’t candidates for open-chest surgery, which has higher risks.
  • Shorter recovery time.

What happens before aorta 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, 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 aorta surgery take?

The time needed for aorta surgery depends on which procedure you’re having, among other factors. An abdominal aortic aneurysm surgery takes three to six hours. However, if it’s done with an endovascular method, it takes about two to five hours.

Examples of other surgery times:

  • A thoracic endovascular aortic repair: about two hours.
  • A more complex repair: three to eight hours.
  • An aortic dissection repair: six 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 can use 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 toward your belly, your provider can reach it through a cut between your ribs (thoracotomy). They can also make the repair by threading a stent through your arteries and placing it inside the aneurysm. This is a thoracic endovascular aortic repair.

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

Generally, if your aneurysm extends from the aortic root down to the aortic bifurcation, your surgeon operates on the aortic root, ascending aorta and arch (the beginning part of your aorta, as it comes out of the heart), as a first stage.

Then, after recovery, your surgeon plans a second stage for the remaining descending thoracic and abdominal aneurysm. That’s not always the case. Sometimes they have to individualize their approach for each person.

During the procedure, your axillary artery (the part of the main artery of your arm) provides blood flow to your body’s organs.

Surgeons can make descending aortic aneurysm 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 can replace 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 a 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.

Aneurysm in your aortic root: The 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 (a valve made of organic material) if your aortic valve isn’t usable.

Surgery for aortic dissection

If you have an aortic dissection 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.

Some people may be able to get an aortic dissection repair without a breastbone incision, if the dissection doesn’t involve their root, ascending aorta and aortic arch. With a thoracic endovascular aortic repair, your surgeon works a stent graft through your arteries to place it in your descending thoracic aorta.

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. They’ll 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 dissection repair, complications include:

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

Complications for aneurysm repair include:

  • Bleeding.
  • Breathing issues.
  • Kidney problems.
  • Leg paralysis.
  • Blood clots.
  • Stroke.

Recovery and Outlook

How long does it take to recover from aortic surgery?

After aorta surgery for an aneurysm, people typically spend a week in the hospital. Also, they need at least a month to recover.

If you have minimally invasive surgery, you may only be in the hospital for one or two days.

After aortic dissection, you can expect to be in the hospital for about a week. However, if you have complications, it could be three or four weeks.

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) surgery than for emergency surgery.

For an abdominal aortic aneurysm, 99% of people survive 30 days after an elective endovascular repair. The survival rate at 30 days is 96% to 98% for surgical removal of that same aneurysm. However, only 50% to 70% survive surgery after their aneurysm ruptures.

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 changing.
  • Order CT or MRI scans.

A note from Cleveland Clinic

Advancements in aorta 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.

Last reviewed by a Cleveland Clinic medical professional on 08/20/2022.

References

  • Abdominal Aortic Aneurysm. In: Crawford MH, Aras M, Sanchez JM. eds. Quick Dx & Rx: Cardiology. McGraw Hill; 2018.
  • Brown CR, Bavaria JE, Desai ND. Ascending and Arch Aortic Aneurysms. In: Cohn LH, Adams DH. eds. Cardiac Surgery in the Adult, 5e. McGraw Hill; 2017.
  • Merck Manual Consumer Version. Multiple pages. Accessed 8/20/2022.
  • National Heart, Lung, and Blood Institute. Aortic aneurysm treatment. (https://www.nhlbi.nih.gov/health/aortic-aneurysm/treatment) Accessed 8/20/2022.
  • Society for Vascular Surgery. Multiple pages. Accessed 8/20/2022.
  • The Society of Thoracic Surgeons. Multiple pages. Accessed 8/20/2022.

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