Repair of an Ascending Aortic Aneurysm

What is surgical repair of an ascending aortic aneurysm?

The aorta is the main blood vessel that carries blood away from your heart and to your body. It is shaped like a walking cane with a curved handle. An ascending aortic aneurysm is an abnormal bulging and weakening in your aorta at the point before the curve.

If an aortic aneurysm ruptures, it can cause life-threatening bleeding. An aneurysm at risk for rupture needs surgical repair.

Why might I need ascending aortic aneurysm repair?

If an aortic aneurysm is large or growing, it needs surgical repair as soon as possible. In some cases, you may be able to have surgery later.

What are the risks for ascending aortic aneurysm repair?

An aortic aneurysm repair is major surgery that needs anesthesia. This has brain and heart risks. Major surgery also carries a risk for blood clots in the large veins of your legs during or after surgery. These clots can break free and travel to your lungs. This condition is called a pulmonary embolism. Other risks of aortic aneurysm repair include:

  • Bleeding
  • Infection
  • Swelling
  • Heart problems
  • Stroke
  • Lung infection
  • Respiratory failure
  • Kidney failure
  • Irregular heart rhythms

You may have other risks, based on your specific medical condition. Be sure to talk with your healthcare provider about any concerns you have before this surgery.

How do I prepare for surgical repair of ascending aortic aneurysm?

Recommendations for getting ready for surgery include the following:

  • Your healthcare provider will explain the procedure and ask if you have any questions.
  • You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • Your surgical team will do a complete medical evaluation. This may include a thorough medical history and physical exam, special X-rays, computed tomography (CT) scans, blood tests, and procedures to check the health of your lungs and heart. Your healthcare provider may also do an echocardiogram of your heart.
  • If you are pregnant or think you might be, tell your healthcare provider.
  • Tell your healthcare provider if you are sensitive to or are allergic to any medicines, latex, iodine, tape, contrast dyes, and anesthetic agents (local or general).

Ask your healthcare provider to tell you what you should do before your procedure. Below is a list of common steps that you may be asked to do.

  • Tell your healthcare provider about any medicines you are taking, including any blood thinners, herbal medicines and over-the-counter medicines. You may be told to stop taking certain medicines before your surgery.
  • If you still smoke, ask your healthcare provider how soon before surgery you need to stop. Smoking increases your risk for blood clots and breathing problems.
  • Stop eating and drinking before surgery, usually after midnight on the night before surgery.

What happens during a surgical repair of an ascending aortic aneurysm?

The operation may take 5 hours or longer. You may need several surgical repairs over your lifetime. This depends on the health of the aortic valve and heart arteries.

  • You will have general anesthesia to make you comfortable and sleep through the surgery.
  • Your surgeon will make a cut in the front of your chest and down through your chest wall, to reach your heart and aorta.
  • During the operation, a device called a heart-lung machine will do the work of your heart. A cold solution will stop your heart so the surgeons can work on a still heart.
  • Your surgeon will remove the bulging weak area and sew a man-made substitute, called a graft, into place.
  • If the aortic valve is not healthy, your surgeon may repair it or replace it with an artificial valve.
  • After your surgeon does all of the repairs, normal blood flow through your heart and your aorta will resume. Your surgeon will then close the incision in your chest. You may have temporary pacemaker wires coming from the skin as well as drainage tubes to drain blood.
  • You will be taken to the recovery area or ICU to be watched closely afterwards.

Talk with your healthcare provider about what you will experience during your procedure. 

What happens after ascending aortic aneurysm repair?

You may need to stay in the hospital for up to 10 days or so after surgery. For the first few days, you will be in the intensive care unit (ICU). Tubes will give you nourishment, help you breathe, and drain fluids from your body. As you recover, your healthcare provider will gradually remove the tubes. During this time, the medical staff will help you care for your incision and start walking. Your healthcare provider will give you medicine to control pain and nausea.

Once you are well enough to go home, you’ll need to follow instructions for medicines, pain control, diet, activity, and wound care. Make sure to keep all your follow-up appointments and to take your medicines as prescribed.

Your healthcare provider may give you other instructions about what you should do after your procedure. Here is a typical list:

  • Avoid any heavy lifting until otherwise instructed.
  • Wait to begin driving until your surgeon tells you it is OK. Have someone give you a ride home from the hospital.
  • Gradually resume normal activities (this may take a few weeks).
  • Ask your healthcare provider when you can resume bathing, driving, working, and sexual activity.
  • When your healthcare provider approves, walk regularly for exercise. Consider 30 minutes, 5 times a week.
  • Watch your wounds for any swelling, redness, bleeding, or discharge.
  • Let your healthcare provider know about any increasing pain, fever, chest pain, shortness of breath, increased swelling, or rapid and irregular heart rhythms.
  • Eat a heart-healthy diet and maintain a healthy weight. Avoid foods that are high in salt and fat.
  • Keep your blood pressure under control. High blood pressure puts stress on the incision sites and on the heart.
  • Don't smoke or use tobacco products.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

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