Learn about Ascending Aortic Aneurysm Repair and Surgery

The main blood vessel that carries blood from your heart to your entire body, the aorta, is like the main pipe that comes from our water tank at home. Sometimes this pipe becomes weak and starts to bulge out like an old balloon. In medicine, we call this an aneurysm. Especially if the part closest to the heart, the ascending aorta, bulges out like this, it can be a bit serious. Today we will talk about the surgery that is done for this condition.

How is this surgery done?

Simply put, this condition is corrected with traditional open surgery. Your cardiac surgeon removes the weakened and swollen part of your aorta and replaces it with a tube made of synthetic material, called a graft. This graft acts as a new lining for your aorta. Blood then flows through it without any obstruction. This surgery is performed in a hospital operating room.

Who needs this surgery?

If an aneurysm in your ascending aorta ruptures or dissects , it is an emergency. We call this a Type A dissection. This is an emergency surgery that must be done immediately to save your life.

Also, if you have an aneurysm that is at risk of bursting or rupturing, you may need to have this surgery. Your doctor will do imaging tests (such as CT scans, MRI scans) once or twice a year to check its condition. Sometimes, if the aneurysm is very small or is growing slowly, surgery may not be needed for a while. However, if it is large or shows signs of growing rapidly , it may need to be repaired surgically before it bursts or ruptures.

What is the best time to have surgery?

Several factors determine the best time to have this surgery. The most important of these is whether you have symptoms. In addition, factors such as the size of the aneurysm, how fast it is growing, your body size, and any other medical conditions you may have also play a role.

Symptoms that require emergency surgery

If you experience chest pain, it could be a sign that the aneurysm is about to burst. In such cases, emergency surgery is needed.

If you experience any of these symptoms, do not delay. Immediately call the 1990 ambulance service or go to the nearest hospital's Emergency Treatment Unit (ETU).

The size of the aneurysm

The size of the aneurysm is a key factor in planning surgery. Surgery may be necessary when it reaches the following sizes:

• Average: 5.5 centimeters
• For those with conditions like Marfan syndrome: 4.5 centimeters
• For those with conditions like Loeys-Dietz syndrome: 4.0 centimeters

The speed at which an aneurysm grows

Even if the aneurysm is smaller than 5.5 centimeters, if it is growing rapidly, surgery will be required soon.

• On average: 1 cm per year or 0.5 cm per 6 months.
• For people with certain conditions (e.g. bicuspid aortic valve): If it grows 0.5 cm per year.

Things that are special to you

Your doctor will also consider your body size and other medical conditions. For example, a small aneurysm in a smaller person can be dangerous, even if it's small. Also, if you have another heart surgery, your doctor may recommend that you repair the aneurysm at the same time as that surgery. This can help prevent future surgeries.

Can't other methods (endovascular) be used for this?

Thoracic endovascular aortic repair (TEVAR) is a procedure used to repair aneurysms in the descending thoracic aorta. However, this procedure is rarely used in the ascending aorta, the artery that starts at the heart. This is because the structure and blood pressure of these two parts are different.

However, in emergency situations, TEVAR has been used to save the life of a patient who is too weak to undergo traditional surgery. Researchers are currently developing new devices that fit the ascending aorta. So this method may become more common in the future. But for now, the best and standard treatment is open surgery.

What happens before the surgery?

You will need to see your doctor a few weeks before the surgery. Your health will be assessed and some necessary tests will be performed.

Commonly performed tests:

• Blood tests: Check kidney function.
• CT or Heart MRI: Examines all parts of the aorta. If there is a problem with the aortic valve, it can also be repaired during this surgery.
• Coronary angiography: Checks for fatty deposits (atherosclerosis) in the arteries that supply blood to the heart.
• Duplex ultrasound: Checks the condition of the blood vessels in the neck (carotid arteries). Problems with these can increase the risk of stroke during surgery.

Things to discuss with the doctor:

• Medications you take: You should tell your doctor about all medications, vitamins, and herbal remedies you take. Some medications may require you to stop taking them before surgery.
• Other diseases: If you have diseases such as high blood pressure, they need to be well controlled before surgery.
• How you feel: Tell your doctor if you have any illness, such as a cold, flu, or herpes.
• Smoking: Smoking should be completely stopped at least one month before surgery.

Your doctor will give you clear instructions on the day of your surgery. Following those instructions exactly is very important for the success of your surgery.

What happens during the surgery?

During the surgery, you will be put under general anesthesia. So you will not feel anything. The surgeon will make a median sternotomy in the middle of your chest, remove the weakened part of your aorta, and replace it with the graft. At some point during the surgery, you will be connected to a cardiopulmonary bypass machine. This surgery usually takes about 3-4 hours.

What happens after the surgery?

After the surgery, you will be admitted to the intensive care unit (ICU). There you will be monitored for a few days. After that, you will be transferred to a general ward. The total hospital stay can be from 4 to 10 days.

While in the hospital,

• You will have a urinary catheter inserted.
• Medications (anticoagulants) are given to prevent blood clotting.
• Special compression socks are worn to prevent blood clots in the legs.
• You may be connected to a machine to help you breathe.
• Painkillers will be given to reduce the pain.

You need to start walking slowly and regain your strength. But everything should be done slowly, according to the doctor's instructions. Since you can't drive a car on the way home, it is essential to have someone to accompany you.

The benefits, risks, and recovery time of this surgery

Things to follow during recovery

• Avoid driving: Do not drive until your doctor gives you permission.
• Avoid lifting weights: Do not lift more than 10 pounds (4.5 kg) for 4-6 weeks.
• Exercise: Avoid strenuous exercise that makes you feel short of breath. Ask your doctor what exercise is right for you.
• Incision Care: Keep the incision clean. Check it daily for signs of redness, swelling, or pus. Holding a pillow against your chest when coughing or sneezing will help reduce pain.

Do I need to change my lifestyle after the surgery?

Yes. It is very important to make some lifestyle changes to reduce the risk of heart disease in the future.

• Eat a heart-healthy diet: especially reduce salt (sodium).
• Exercise: Ask your doctor about exercises that are right for you.
• If you smoke, stop immediately: Smoking causes great damage to your blood vessels.
• Control high blood pressure, cholesterol and diabetes.

When should I see a doctor?

Pay attention to your body during recovery. If you have any of the following symptoms, call your doctor immediately.

It's normal to have a lot of questions before having a surgery like this. Talk to your doctor about all of them openly. When a doctor recommends this surgery, they are saying that the risks of not having the surgery are much higher than having it. People who recover from planned surgeries go on to live normal lives. So with the right medical team and proper care, you can recover quickly and get back to your normal life.