How is a thoracic aortic aneurysm treated with surgery?

The current standard surgical treatment of a thoracic aortic aneurysm is the open-chest approach. The main purpose of open-chest surgery to treat a thoracic aneurysm is to replace the weakened portion of the aorta with a fabric tube, called a graft. Repairing a thoracic aneurysm is surgically complicated and requires an experienced thoracic surgical team. However, neglecting the aneurysm presents a higher risk.

Preoperative evaluation

To help ensure the best outcome of thoracic aneurysm surgery, you will undergo a thorough preoperative evaluation to check for atherosclerosis (a hardening of the arteries that damages the artery’s walls) in the body’s blood vessels. Preoperative evaluation may also include:

• Screening of left ventricular (the heart’s left side) function and an assessment for the presence of coronary artery disease

• Ultrasound examination

• Pulmonary function testing with a spirometer to measure lung function.

How is surgery for a thoracic aortic aneurysm completed?

Thoracic aneurysms occur above the diaphragm, including in the ascending aorta, the aorta arch and the descending thoracic aorta. The location of a thoracic aneurysm determines many factors, including where the incision for surgery is made. If the aneurysm is close to the aortic valve, an incision in the front of the chest (median sternotomy) may be used. An aneurysm close to the aortic valve may also require the valve to be repaired or replaced. If surgery is needed on the aortic arch, the procedure is approached from the front chest area. A standard incision for an aneurysm in the descending thoracic aorta is made on the left side of the chest (left thoracotomy).

After making an incision in the chest, your thoracic surgeon will replace the weakened portion of the aorta with a graft. The graft is made of a material that is stronger than the weakened aorta, allowing blood to pass through the vessel without causing a bulge

Many patients who have a thoracic aneurysm may also have heart valve disease, disease of the aorta next to the heart, or extensive aorta disease, leading into the abdomen or other major arteries. For those thoracic aneurysms that are extensive or more complex, heart surgery is sometimes performed at the same time as an open-chest aneurysm repair. In addition, thoracic surgeons may work along side vascular surgeons to complete a complex procedure involving the entire aorta or peripheral blood vessels.

What are the risks of thoracic aortic aneurysm surgery? The risks involved with repairing a thoracic aneurysm depend on the extent of the repair required, the length of surgery and on your overall general health. Your surgeon will talk with you about the possible risks and benefits of the procedure. Complications after thoracic aneurysm surgery may include:

• Heart attack

• Irregular heartbeats

• Bleeding

• Stroke

• Paralysis due to injury of the spinal cord

• Graft infection

• Kidney damage

How long will it take to recover from thoracic aortic aneurysm surgery?

Your length of hospital stay following thoracic aneurysm surgery depends on your condition and the operation performed, but it is typically 7 days. Most people need at least 4 to 6 weeks to recover from thoracic aneurysm surgery. If your aneurysm is extensive, involves intervention to repair other complications, or if you have other conditions such as heart, lung or kidney disease, recovery may take 2 to 3 months. After you’ve had surgery to repair an aneurysm, it is recommended you adopt the same heart-healthy lifestyle led by other heart surgery patients. Your health care team can provide more information.