Surgical Treatments

 

People diagnosed with aortic aneurysm might wonder what happens next. There are many possible treatment options for aortic aneurysm. If surgery is the best option for you, our multidisciplinary team of aortic experts can guide and prepare you through your surgical journey.

Surgery

Please choose one of the following options to read more about surgery to treat aortic disease.

• The aortic root
  
• The aortic arch
• Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair

Aortic Root Surgery

The aortic root contains the aortic valve and the coronary arteries. Your doctor may recommend surgery if an aneurysm in the aortic root is causing the aortic valve not to open and close properly.

What is the Bentall procedure?

• Surgery that replaces the entire aortic root, including the valve
• Valve may be mechanical or made of biological tissue
• Re-attaches the coronary arteries. There are pros and cons to choosing one valve type over the other. You and your surgeon will discuss what valve may be the right choice for you.

What is valve-sparing root replacement?

• Surgery that replaces the aortic root but keeps the aortic valve
• Done if the aortic valve is fairly healthy
• We then re-attach the coronary arteries.

Pros:

• lower risk of infection
• better blood flow
• no blood thinner medicine (warfarin)
• mechanical valve lasts longer than biological valve (valve made from animal tissue)

Cons:

• longer OR time
• not always feasible if aortic valve is not perfect

What is the Ross procedure?

 

• Replaces the aortic valve with your own pulmonary valve. Your pulmonary valve is then replaced with a human donor valve.
• Done when it is not possible to keep your aortic valve and when using a prosthetic valve is not possible.

Pros:

• lower risk of infection
• excellent blood flow
• no blood thinner medicine (warfarin)
• pulmonary or human donor valve lasts longer than biological valve (valve made from animal tissue)
• superior long-term survival

Cons:

• complex surgery involving 2 valves, instead of 1
• neither pulmonary or human donor valve lasts as long as a mechanical valve

Aortic Arch Surgery

The aortic arch is the curved part of the aorta that carries blood to your head, neck, brain and arms. We offer the open, hybrid and endovascular repair of the aortic arch.

What is open surgery?

• Replaces the section of the aorta affected by the aneurysm with a durable fabric tube (graft) connecting the healthy ends of the aorta.
• Surgery is done with the heart-lung machine. This way your brain is perfused and protected.

What is endovascular surgery?

• A device called a stent graft is put inside the aorta to divert the flow of blood away from the aneurysm. Smaller stents are used for the branches of the arch.
• Sometimes the surgeon needs to do smaller open operations before or at the same time as endovascular surgery to reduce the risk of complications.
• Your surgeon may recommend endovascular surgery depending on your health and other factors (such as age, medical history and health conditions).

Pros:

• minimally invasive (done using few small cuts and stitches)

Cons:

• not always possible based on patient’s anatomy (For example, small vessels)
• less versatile than open repair
• device-related complications including endoleaks, graft migration or collapse

What is hybrid surgery?

• A combination of graft and stenting for patients with aortic disease involving a large extent of aorta.
• May be done in stages to lower the risk of complications.

Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repair

An aortic aneurysm that involves your chest and continues down into your abdomen is called a thoraco-abdominal aortic aneurysm or TAAA.

 

TAAA repair is a very complex procedure. There are different ways to do the surgery (open surgery or endovascular repair) depending on the type of aneurysm.

What is open surgery?

The surgeon makes a long incision (cut) along the left side of the chest, between the ribs and down towards the belly button (umbilicus) in the lower abdomen. The weakened part of your aorta is replaced with a fabric tube called a graft.

What is Endovascular Aneurysm Repair (EVAR)?

This is a less invasive way to manage your aneurysm. A catheter is inserted into an artery in your groin and a device called a stent graft (fabric tube) is put into your aorta to seal off the aneurysm from the inside.

 

To repair a thoracoabdominal aortic aneurysm, or one close to the kidney arteries, a surgeon will often use a custom-made graft with branches or openings to re-attach important arteries of the abdominal aorta.

 

What is lumbar or spinal drain?

The lumbar or spinal drain collects cerebrospinal fluid (CSF) during and after surgery. CSF is the clear fluid that surrounds and protects your spinal cord and brain. Too much pressure in the fluid around the spinal cord can cause damage to the cord leading to paralysis of the legs and lower part of the body.

Before the surgery, a drain catheter is put into the fluid surrounding your spinal to reduce the pressure in your spinal cord and lower the risk of paralysis.

You can find more information on TAAA :

• Repair of Your Thoraco-Abdominal Aortic Aneurysm (TAAA)