What is Thoracic Aortic Procedure?
The aorta is the largest artery that supplies oxygen-rich blood from the heart to the entire body. It arises from the left ventricle (heart’s lower left chamber), arches over the heart, and runs down the chest and abdominal region where it branches out. The aorta is classified based on its location, and the region that extends down the chest is called the thoracic aorta.
Deposition of plaque (calcium, cholesterol, and minerals) or certain related diseases can weaken the walls of the thoracic aorta, causing it to bulge or expand, and sometimes burst, leading to hemorrhage (bleeding). This condition is called a thoracic aorta aneurysm. Some factors that may increase the risk of aneurysm are familial history, high blood pressure, cholesterol and smoking. This condition can be treated with thoracic aortic surgery.
Indications of Thoracic Aortic Procedure
- Surgery is recommended for the following:
- Large aneurysms that are growing quickly (more than 1 cm/year)
- Manifestation of symptoms (pain in the chest, back, jaw and neck)
- Risk of rupture
- Associated with other diseases like Marfan's syndrome (a disease that affects tissues that hold the body’s cells, tissues and organs together)
- Aortic dissection (tear in the aortic wall)
Pre-operative Procedures
You will undergo a few pre-operative tests such as an ultrasound scan and pulmonary function test (to check lung function) before the surgery. Tests are run to check for hardening of the arteries in the body and the presence of coronary artery (artery supplying the heart muscles) disease.
Procedure of Thoracic Aortic Surgery
Thoracic aortic surgery is performed under general anesthesia. There are two types of procedures to repair a thoracic aortic aneurysm.
- Open surgical repair: During this procedure, your surgeon makes an incision on the left side of your chest to access the thoracic aorta. The weakened part of the aorta is removed and replaced with a graft (plastic tube). This graft is stronger than the damaged aorta and allows blood to pass through freely. Once the surgery is complete, your surgeon sutures and bandages the incision.
After surgery, you will have to stay in the hospital for about 7 to 10 days. It may take about 2 to 3 months for you to completely recover.
- Endovascular stent-graft repair: This is a relatively new procedure performed using a thin long tube called a catheter. A small incision is made in your groin or sometimes in the arm. The catheter inserted through this incision is guided to the aneurysm in the thoracic aorta through a blood vessel in the groin. X-ray imaging is used to view live pictures of your heart and to guide a stent-graft (wire mesh) through the catheter to the site of the aneurysm. The stent helps the flow of blood through the aorta without pressure being exerted on the weakened aortal wall. It also strengthens the aortal wall and prevents it from rupturing.
Your hospital stay after endovascular surgery will be for 2 to 3 days. Post-operative follow-up from time to time is required to keep a check on the proper functioning and position of the stent-graft. Over time, the weakened and expanded thoracic aortic wall will shrink over the stent.
Complications
Like all surgical procedures, thoracic aortic surgery may also include certain complications such as:
- Bleeding
- Paralysis due to spinal cord injury
- Graft infection
- Irregular heartbeat
- Heart attack, kidney damage, and stroke
Your doctor will review the benefits and risks of the surgery and suggest the best procedure to treat the thoracic aortic aneurysm.
