The aorta is a large artery that leaves the heart and provides oxygen rich (red) blood throughout the body. Many diseases and conditions can cause the aorta to widen (and lead to aortic aneurysm) or tear (aortic dissection) and will require surgery. These diseases and conditions include:
- Atherosclerosis (hardening of the arteries)
- Hypertension (high blood pressure)
- Congenital conditions (such as Marfan Syndrome)
- Connective tissue disorders
Surgical repair of the aorta can be performed using either conventional open heart surgery or in some instances via endovascular surgery. Endovascular surgery is a minimally invasive technique that is performed using long surgical tubes called catheters that are inserted into the aorta (via blood vessels in the groin) to repair aortic damage or defects.
AORTIC ROOT REPLACEMENT/REPAIR
In aortic root surgery, cardiovascular surgeons typically remove a section of the aorta root and the aortic valve in the heart. The damaged aortic section that was removed is replaced with tube made from artificial materials called a graft and the aortic valve is replaced with a mechanical or biologic valve.
In valve-sparing/preserving aortic root repair surgeons replace damaged or enlarged portions of the aorta with a graft but do not surgically remove the aortic valve. The aortic valve is sparred if it is not damaged and functioning normally.
AORTIC ANEURYSM RESECTION/REPAIR
Aortic aneurysms are abnormal bulges in a weakened portion of the wall of the aorta. Aneurysms that occur in the section of the aorta that runs through the abdomen (abdominal aorta) are called abdominal aortic aneurysms whereas those that occur in the chest area are called thoracic aortic aneurysms can involve the aortic root, the ascending aorta, aortic arch or descending aorta. Thoracoabdominal aortic aneurysms involve the aorta as if flows through both the abdomen and chest.
The treatment options vary depending on the location of the aneurysm. In the ascending aorta, current standard surgical treatment involve open surgery where the aorta is replaced with a tube graft. In the descending aorta (thoracic aneurysm) or abdominal aorta (abdominal aneurysm) endovascular sugery is more commonly the answer. Thoracoabdominal aneurysms are complex and of varying types. Open or endovascular surgery may be employed.
ENDOVASCULAR AORTIC ANEURYSM
Endovascular aortic aneurysm surgery is a minimally invasive procedure that uses long thin catheters inserted inside of the aorta (via blood vessels in the groin) that guide and deliver stent grafts to the site of the aneurysm.
Deployment of the stent graft in the diseased segment of the aorta relines the aorta like a sleeve restores integrity to the aortic wall and diverts blood flow away from the aneurysm.
Minimally invasive endovascular stent grafts can be used to treat thoracic, abdominal and thoracoabdominal aortic aneurysms. Endovascular repair of aortic aneurysms is generally less painful and lowers the risk of complications associated with traditional open surgeries because the incisions are smaller. Patients who undergo endovascular aortic aneurysm surgery generally leave the hospital earlier and recover more quickly than patients undergoing traditional open heart procedures. Not every patient is a candidate for endovascular surgery.
ACUTE /CHRONIC AORTIC DISSECTION
Aortic dissection is a condition that forces the layers of the wall of the aorta to push apart, separate and tear because of increased blood flow through the artery. Aortic dissection usually has a sudden onset and it may be described as sharp, stabbing or tearing pain the chest and back.
People with high blood pressure, aortic valve defects or connective tissue diseases such as Marfan syndrome that affect blood vessel wall integrity may be at risk for aortic dissection. Sometimes, acute events like heart attacks or fluid accumulation around the lungs and diaphragm or blunt force trauma (car accidents) can cause aortic dissection.
Surgery is generally required especially with thoracic aneurysms or dissections involving the ascending aorta and the aortic arch. Aortic dissection surgery can be performed using traditional open-heart procedures or by endovascular surgery that uses long thin catheters inserted inside of the aorta (via blood vessels in the groin) that guide and deliver stent grafts to the site of the defect for surgical repair.
HYBRID AORTIC PROCEDURES
Based on a patient's general health and severity of an aortic defect, some cardiovascular surgeons may elect to use a hybrid surgical approach to repair damaged aortas. Hybrid aortic surgery generally involves traditional open heart surgery in combination with endovascular stent graft procedures.
Endovascular aortic surgery uses long thin catheters inserted inside of the aorta (via blood vessels in the groin) that guide and deliver stent grafts (artificial fabric mesh "patches") to the site of the defect for surgical repair.