What is aorta surgery?
Aorta surgery is a procedure to repair or replace damaged sections of the aorta, the body’s largest artery. It’s necessary when conditions like aneurysms, dissections, or ulcers affect the aorta, which can lead to life-threatening complications. Surgeons may use open surgery or hybrid surgery, a combination of open and catheter-based techniques, to repair the damaged aorta, often replacing it with a synthetic graft.
At Penn Medicine’s Aorta Center, our cardiac and vascular surgeons are leaders in complex aorta surgeries. With vast experience in these technically demanding procedures, our surgeons routinely and successfully treat even the most serious conditions. People benefit from our advanced techniques, collaborative team approach, and state-of-the-art facilities, including our hybrid operating room for combined procedures.
Who is a candidate for aorta surgery?
You may be a candidate for aorta surgery if you have one of the following conditions, or other serious aortic disease:
- Aortic aneurysm
- Aortic arch syndrome
- Aortic dissection
- Aortic ulcer
- Aortic valve stenosis
- Aortic regurgitation
- Coarctation of the aorta
Standard open-chest surgery may be the recommended approach for those with complex or challenging conditions.
Some people with aortic disease have medical conditions that put them at risk for complications with traditional open-chest aorta surgery or make them ineligible for thoracic endovascular aortic repair (TEVAR). If you have a chronic condition like heart disease, advanced aortic disease, or previous aortic surgery, you may be a candidate for hybrid aorta surgery.
Your surgeons will assess your individual risk factors and health history to determine the most suitable treatment plan for you.
What to expect from aorta surgery
Before your surgery, your care team will provide personalized guidance on how you should prepare, which may include information on medications, lifestyle adjustments, and the specific steps of your procedure.
Aorta surgery is performed in a specialized operating suite where a cardiac anesthesiologist ensures you are comfortably asleep. The surgeon makes an incision, connects you to a heart bypass machine, and removes the damaged section of the aorta. They replace it with a synthetic graft and, if necessary, perform additional procedures such as valve repair or replacement.
For certain cases, hybrid aorta surgery may be used, combining open surgery with catheter-based techniques to repair complex aneurysms. This approach minimizes risks for high-risk patients and can reduce recovery time.
The standard surgery for larger or difficult-to-access thoracic aneurysms, ulcers, or dissections is open-chest surgery performed by experienced cardiac surgeons. Your cardiac surgeon will take care to perform the least invasive surgery possible.
To have ample access and visualization of the damaged aorta, the approach may include an incision through the breastbone (sternotomy) or under the shoulder blade and around the rib cage under the breast (thoracotomy).
Next, your surgeon:
- Connects you to a heart bypass machine, which takes over the work of pumping blood to your body
- Surgically removes the damaged section of the aorta and replaces it with a rigid synthetic graft (tube)
- Removes the heart bypass machine and ensures your heart is beating properly
- Closes your incision
In some cases, your surgeon may need to perform additional procedures when performing aortic aneurysm or dissection surgery:
- If the damaged section of the aorta is near the junction of the aorta and heart (the aortic root), they may perform valve-sparing aortic root repair.
- If your aortic valve is damaged, your surgeon may need to perform aortic valve replacement or repair surgery to correct or entirely replace the native valve.
- Whenever possible, we perform transcatheter aortic valve replacement (TAVR), which is a minimally invasive procedure.
Hybrid aorta surgery uses both surgical and catheter-based procedures to provide a lifesaving treatment option for those with conditions that put them at high risk. Using this approach, your surgeon performs aortic repair surgery in two stages: open surgery followed by endovascular surgery. These may be performed in a single operation or scheduled as separate sessions.
During the open surgery stage, your surgeon:
- Creates an incision in the chest to gain access to blood vessels at or near a thoracic aortic aneurysm
- Reroutes the vessels to a healthy part of the aorta and ensures the blood supply is re-established
- Closes the incision and, if performed in a single operation, proceeds to the second stage
During the endovascular stage, your surgeon guides a tube (catheter) through a small incision (usually in the groin) up to the damaged section of the aorta using x-ray guidance. Next, your surgeon:
- Slides an endograft (a synthetic implant that will act as a replacement aorta) into the catheter and advances it to the damaged section of the aorta
- Expands the implant and fastens it in place
- Removes the catheter and closes the incision
Recovery from aorta surgery
Aorta surgery recovery time varies depending on the individual and the complexity of the surgery. Your Penn Medicine care team will review specific post-surgery recovery guidelines with you.
After aorta surgery, most people stay in the hospital for up to a week for close monitoring. Recovery often involves participation in cardiac rehabilitation, where specialists guide you through exercise, nutrition, and education to speed healing.
For hybrid aorta surgery, benefits include shorter surgery times, reduced anesthesia, and faster recovery compared to traditional open-chest surgeries. Most people can resume normal activities within six to eight weeks, with regular follow-up appointments to monitor progress.
Risks of aorta surgery
As with any major surgery, aorta surgery carries some risks. These can include bleeding, infection, blood clots, breathing problems, heart attack, or stroke. Kidney complications and the potential need for a pacemaker are also possible. In some cases, late-onset complications like aortic insufficiency or the need for additional surgery may arise. However, these risks are relatively uncommon, and, with proper care and follow-up, most people experience successful outcomes.
Trust the leaders in aortic disease treatment
Penn Medicine’s experienced cardiology teams are committed to delivering more options, more personalized care, and, with multiple locations, more convenient care. Our researchers are tirelessly pursuing new advances in prevention, diagnosis, and treatment of heart and vascular conditions.
Our cardiac and vascular surgeons are internationally recognized for their care of complex aortic disease. We treat more people with aortic disease than any other hospital in the southeastern Pennsylvania and New Jersey regions. Our outcomes are better than the national benchmarks, even though many of the people we treat have complex aortic disease that can’t be managed elsewhere. When you need advanced heart care, we’re here for you.
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Susan Helfrich's care for ascending aortic aneurysm was not only life-saving; it was life-changing.