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Ascending aortic surgery:
The aorta is the main artery of the human body, responsible for distributing oxygenated blood after it leaves the heart. Its birth occurs at the exit of the left ventricle of the heart. The aortic valve separates both structures. The aorta is divided into:
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Ascending aorta: it is the portion that runs between the aortic valve and the aortic arch. It includes the aortic root (initial portion of the aorta), from where the coronary arteries that supply the heart leave.
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Aortic arch: it is the area that separates the ascending aorta from the descending thoracic aorta and is shaped like an arch, which is why it is also called the aortic arch. From it arise the arteries that supply the head (including the brain) and the arms (carotid and subclavian arteries respectively).
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Descending thoracic aorta: it is the portion between the aortic arch and the diaphragmatic area. It gives rise, among others, to arteries that supply the spinal cord and the thoracic wall.
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Abdominal aorta: it is the final section of the aorta that runs between the diaphragmatic area and the aortic bifurcation, where it divides into the right and left common iliac artery. Branches of the abdominal aorta are the arteries that supply the abdominal viscera (liver, stomach, spleen, pancreas, intestines ...) including the celiac trunk and the superior and inferior mesenteric arteries.
An aneurysm is the equivalent of a dilation. In the case of the ascending aorta, a dilation of the wall of the aorta that, like an inflating balloon, grows in size. It has been shown that when it reaches a certain maximum cross-sectional diameter, there is a considerable risk of breakage. A ruptured aortic aneurysm is a very serious condition that is often fatal. For this reason, with an ascending aorta diameter of 5.5 cm, surgical intervention is indicated. In particular cases (Marfan syndrome, bicuspid aortic valve, concomitant cardiac intervention…) this diameter may be smaller.
An aortic dissection is the separation of the layers that make up the aortic wall due to the entry of blood into its interior, generally through an entrance door, “intimal flap” or tear of the innermost (intimate) layer of the aorta . In the case of the ascending aorta, it is a life-threatening disease that requires urgent surgical intervention.
What is the surgical intervention?
The surgical procedure consists of cutting the section of the diseased aorta and replacing it with a tube or graft made of a very resistant tissue (dacron). If the aortic valve is diseased, it must be repaired or replaced, which is usually done by implanting a valved tube, that is, a graft with a prosthetic valve sewn to its end. This technique is called Bentall-Bono.
Ascending aorta interventions are performed with extracorporeal circulation.
Depending on the segment of the aorta affected (whether or not it includes aortic arch, whether there is generalized involvement of the aorta ...) the intervention will also require moderate or profound hypothermia and circulatory arrest. This entails lowering the temperature of the body and especially the brain to be able to stop circulation safely during the time necessary to change the diseased segment. In isolated ascending aortic aneurysms, this is not necessary.
Before the intervention
Except in urgent cases, the intervention will be carried out on a date suitable for you and with the availability of an operating room by the surgeon. You should inform him of your recent health status including if you have had a cold, tooth decay, or fever. Remember to bring the medications you are taking or have taken in recent days to the Hospital. You will probably enter the day before or the morning of the intervention.
You will need to bathe with an antiseptic solution and the area near the surgical field will be shaved. With this we avoid future infections. You will be fasting from midnight before the intervention, in order not to suffer anesthetic complications. For this same reason, it is advisable that in case of smoking, do not do so for at least two weeks prior to the intervention.
After admission, an electrocardiogram, a blood test and a chest X-ray will be performed (if not already done).
As part of your pre-anesthetic medication, you will likely be given a sedative to help you relax before going to the operating room. Once in the operating room, you will be given a route through which to administer anesthetic drugs. You probably do not remember this after the intervention.
During the intervention
Once you are asleep, a series of tubes and probes will be inserted:
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Endotracheal tube: allows connection to a respirator during surgery
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Nasogastric tube: it is inserted through the nose and reaches the stomach, so that fluids and air do not accumulate and you do not suffer nausea or vomiting when you wake up.
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Bladder catheter: it is introduced through the urethra and reaches the urinary bladder, which allows urine to be collected during the intervention, preventing the bladder from filling up and making it possible to know the functioning of the kidneys.
During the procedure, you will be given heparin, an anticoagulant that prevents the blood from clotting while you are having surgery. Before ending the intervention, an "antidote" is administered, protamine, which reverses this action.
You will be left between 1 and 3 drainage tubes, which serve to evacuate the normal initial bleeding that occurs after the intervention. Cardiac surgery can lead to increased initial excitability of the heart tissue, so you will be implanted between 1 and 5 epicardial pacemaker electrodes, connected to the heart and protruding from the lower edge of the ribs. These electrodes allow the placement of a temporary pacemaker in case of rhythm disturbances during the initial postoperative period.
The operation can last between 2 and 6 hours on average, although in the case of complex dissections or involvement of the aortic arch, the duration can be considerably longer.
Postoperative
Initially, you will be admitted to the intensive care unit (ICU) where you will wake up between 3 and 9 hours after the end of the operation. When you are able to breathe on your own, the endotracheal tube will be removed. When the drainage tubes stop draining (generally the next day) they will be removed and after 24-72 hours on average, they will be discharged to the plant, where they will remain between 3 and 7 days on average. This will depend on the type of underlying disease.
Life after ascending aortic surgery
After this intervention, you should reduce the consumption of animal fats and cholesterol. You can walk or swim slowly and a cardiac rehabilitation program that includes a specific balanced diet, smoking cessation and stress management would be appropriate.
In addition, you must continue taking drugs that prevent the progression of the disease. You may need to take drugs to remove fluids (diuretics). In addition, you may need to take an antiplatelet and a cholesterol-lowering drug (statin), unless you are allergic to them. If you have a mechanical valve implanted, you will need to take Sintrom® (see Valve Surgery).
In 4 to 6 weeks you will be able to return to an office job. In case your job requires physical exercise or significant stress, this time may be extended or even require a leave or change of employment in extreme cases.