Ascending aortic aneurysm repair is a traditional open surgery. It fixes an aneurysm in the first part of your aorta that comes out of your heart. It’s highly successful when performed before aneurysm rupture or dissection. Recovery usually takes four to six weeks. Making lifestyle changes after surgery can help you live a long, healthy life.
An ascending aortic aneurysm is repaired through traditional open surgery. Your surgeon removes the weakened part of your ascending aorta and replaces it with a graft (synthetic fabric tube). This graft functions as a new lining for your artery so blood can pass through.
A cardiac surgeon performs this procedure in a hospital surgical suite.
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If you have a ruptured or dissected aneurysm in your ascending aorta, you have what’s called Type A dissection, and you need surgery. It’s an emergency surgery that can save your life.
You might also need surgery if you have an aneurysm that’s at risk of rupture or dissection. Your provider will check your aneurysm once or twice a year using imaging tests. Sometimes an aneurysm that’s very small or stable in size doesn’t need treatment for a while. But if the aneurysm is large or shows signs of rapid growth, you’ll 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 (six out of 10) occur in the ascending aorta. Less often, they occur in the descending aorta or aortic arch.
The best timing for ascending aortic aneurysm repair depends on many factors. The most important is whether you have symptoms. Others include the aneurysm’s size and how fast it’s growing. Your body size and your particular medical conditions also play a role.
If you have chest pain, you might need emergency surgery. This could signal the aneurysm is about to rupture.
Call 911 if you have the following symptoms:
Aneurysm size is one of the key factors that determine when you need elective (planned) surgery. You may need surgery when the aneurysm diameter reaches:
You’ll need surgery soon if your aneurysm is growing quickly. That’s true even if the aneurysm is considered smaller (below 5.5 centimeters). You need surgery if:
Your provider will also take into account individual factors like your body size and medical conditions. For example, someone with a smaller body size may need surgery sooner. Your provider will use a formula to calculate the risk of rupture based on your body size and aneurysm size. This can lead to surgeries for aneurysms below 5 centimeters in diameter.
If you need another type of heart surgery, your provider may advise aneurysm repair at the same time. In that case, the aneurysm diameter could be as small as 4 centimeters. It’s wise to fix it sooner to prevent future problems and avoid multiple surgeries.
Your provider will talk with you about your unique needs. Your age, family history and underlying medical conditions can impact how you respond to the surgery. So, your provider will weigh the risks and benefits of having surgery sooner rather than later. Ask your provider if you have questions or concerns at any point.
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Thoracic endovascular aortic repair (TEVAR) repairs aneurysms in your descending thoracic aorta. That’s the part of your aorta that extends from the aortic arch down to the diaphragm. But TEVAR is rarely used for your ascending aorta (the first part that comes out of your heart). These two parts of your aorta (ascending and descending) 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.
You’ll have a physical exam several weeks before your surgery. Your provider will run tests and also talk with you about your health. Preoperative tests may include:
You’ll talk with your provider about:
Your provider will give you detailed instructions for the day of your surgery. These may include:
Be sure to ask your provider if you have any questions or if anything is unclear. Good preparation is essential for a successful surgery.
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Your surgeon will replace the weakened part of your aorta with a graft (synthetic fabric tube). 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 aorta’s condition as well as your medical history and family history.
Once you’re moved to the operating room, your care team will help you feel comfortable and relaxed. You’ll be given general anesthesia that puts you to sleep during the surgery. During parts of your surgery, you’ll be on a heart-lung machine (cardiopulmonary bypass). Your care team may also use deep hypothermic circulatory arrest (DHCA) 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.
You’ll be moved to the intensive care unit (ICU). You’ll be closely watched for a few days before moving to a regular hospital room. Your total hospital stay will likely be four to 10 days.
While you’re in the hospital, you’ll receive:
You’ll slowly move around more to regain your strength. But it’s important to follow your provider’s guidance and take things slowly.
Make sure to find someone to drive you home from the hospital. You won’t be able to drive until your provider says it’s OK.
As an elective surgery, ascending aortic aneurysm repair prevents a rupture or dissection. Open surgery is currently the standard treatment method. It helps you avoid a medical emergency so you can keep on living your life.
Emergency surgery to repair a dissected or ruptured ascending aortic aneurysm can save your life.
Ascending aortic aneurysm repair is major surgery. Like any major surgery, it carries risks and complications. These include:
Any open surgery is riskier for people with other serious health problems, including:
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.
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 don’t 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.
The life expectancy is normal for those who have elective surgery (before a rupture or dissection). One study shows that people who have elective ascending aortic aneurysm repair live just as long as the general population.
Most people stay in the hospital for up to 10 days. But you may need more time depending on your condition. You may also benefit from cardiac rehab after you leave the hospital. This helps you regain your strength and independence.
Full recovery usually takes four to six weeks. But some people need several months to fully get back to normal.
Your provider will give you detailed recovery instructions. These may include restrictions like:
Take your prescription pain medication at the same time each day. This may help your medicine work most effectively.
Your incision is the area on the front of your chest that was cut open for surgery. Now it’s closed, but it’s still a wound. It needs special care as you recover. Your provider will tell you how to care for it. You’ll likely need to change the dressing (bandages) every day. Only remove the dressing to take a shower if your provider says it’s 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.
You may notice you’re not as hungry as usual. This is normal. It can take a few weeks for your appetite to return. Some people lose up to 20 pounds as they recover from aneurysm surgery.
You may also feel tired for several weeks. This is a normal part of healing. Talk with your provider about how you’re feeling and share any concerns you have.
It’s important to make lifestyle changes to reduce your risk of future heart problems. These include:
As you recover from your surgery, stay aware of your body and how you’re feeling. Call your provider if you notice any of these problems.
Incision (surgical wound) problems:
Other problems:
These problems may signal a complication from surgery. Your provider will make sure you get the care and attention you need.
A note from Cleveland Clinic
If you’re planning to have ascending aortic aneurysm repair, it’s normal to have many questions. Your provider will talk with you about the risks and the benefits of this surgery. Like any major surgery, it involves some risks. But if your provider recommends surgery, that means it’s riskier to wait than to operate. Most people survive elective aneurysm repair surgeries and go on to live just as long as people without aneurysms. But ruptures and dissections are often fatal. With the right resources and care team, you’ll be on the road to recovery and feeling strong again in no time.
Last reviewed on 04/01/2022.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy