Type of Surgery
Information
Last updated: 11/24/2009
After general anesthesia is administered, the surgeon will make an incision through the length of the sternum to repair an ascending, arch, or thoracic aortic aneurysm. Abdominal aneurysms are approached through a vertical incision in the abdominal...
wall. Depending on the location of the aneurysm, cardiopulmonary bypass with deep hypothermic circulatory arrest (arch), cardiopulmonary bypass (ascending), or left heart bypass (thoracic) may be required. All procedures require some amount of anticoagulation, usually heparin, to be administered to prevent blood clot formation. Clamps will be applied across the aorta to prevent blood flow into the aneurysm. The aneurysm will be opened to an area where the tissue is healthy. The healthy tissue will be sutured to a synthetic fiber fabric graft. The fabric is knit or woven Dacron fibers and may be impregnated with collagen, gelatin, or other substances. Blood flow is reinstituted to check for a secure seal. Additional sutures will be added to prevent leaking. The incision is then closed at the completion of the procedure with blood drains penetrating the incision during healing.
Ascending aortic aneurysms may involve the aortic valve or coronary arteries. If the aortic valve is damaged, a graft with an integral aortic valve is used. The coronary arteries are reconnected to the graft.
Aortic arch aneurysms require the reattachment of the arch vessels, the innominate artery, the left common carotid artery, and the left subclavian artery. To decrease surgery time, these three vessels can be treated as a single vessel by using part of the patient's native aorta to create an island. This island is then connected to the graft.
Thoracic aneurysms require special care to protect the spinal vessels that supply blood to the spinal cord. Protecting the spinal cord during repair is still an area of intensive research. Some surgeons feel that rapid implant of the graft to restore blood flow is the best method to protect the spinal cord. A bypass graft called a Gott shunt can be used to redirect the blood flow around the area during surgical repair. Left-heart bypass provides the same benefit as a Gott shunt, with the addition of a mechanical pump for more controlled blood flow to the abdomen and lower extremities.
The abdominal aortic aneurysm is repaired by rapid anastomosis of the graft to return blood flow to the circulation. If the renal arteries are involved in the aneurysm, they will be reattached to the graft. Additionally, if the superior celiac, mesenteric, or inferior celiac arteries are involved, they will also be reattached to the graft. Finally, it is common for the bifurcation (separation into two) of the iliac arteries to be involved; this may require a Y-shaped graft to be used to reattach both lower limb vessels.
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Your aorta is the major artery leaving the heart, but extends to the abdomen. The video shows how a bulging out of the aorta (abdominal aortic aneurysm) is treated with a stent.
An incision is made in the abdomen (A), and the aneurysm is visualized (B). The aorta is clamped above the aneurysm, and the aorta is cut open (C). The clotted blood is removed (D). A synthetic graft may be used to replace the part of the aorta that had the aneurysm, and it is stitched in place (E). The aorta is then closed over the graft (F). (Illustration by GGS Inc.)
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Other Information
An aortic aneurysm is a general term for any swelling (dilatation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location. While the stretched vessel may occasionally cause discomfort, a greater concern is the risk of rupture, which causes severe pain; massive internal hemorrhage; and, without prompt treatment, results in a quick death.
The definitive treatment for an aortic aneurysm is surgical repair of the aorta. This typically involves opening up of the dilated portion of the aorta and insertion of a synthetic (Dacron or Gore-tex) patch tube. Once the tube is sewn into the proximal and distal portions of the aorta, the aneurysmal sac is closed around the artificial tube. Instead of sewing, the tube ends, made rigid and expandable by nitinol wireframe, can be much more simply and quickly inserted into the vascular stumps and there permanently fixed by external ligature
Other Information
How many open-heart surgeries are performed each year? In 2005 in the United States, these procedures were performed: Valve replacements 106,000 Bypass (cardiac revascularization) 469,000 Heart transplants (performed in 2006) 2,192 Total open-heart procedures 699,000.
From: American Heart Association
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