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Why Choose Penn Medicine

The team of cardiac surgeons at Penn Medicine’s Aortic Center have special training to treat every form of complex aortic disease. One area of expertise is in treating thoracic aortic aneurysms that extend into the arch (the part of the aorta that curves back toward your chest and abdomen). Our team of experts helped to develop and refine a hybrid approach to treatment of arch aneurysms. Our sophisticated hybrid operating room allows surgeons to perform open and catheter-based procedures in the same setting.

Hybrid Aorta Arch Surgery Overview

The aortic arch is a technically challenging part of the body to operate on because it has arteries that branch off to supply oxygenated blood to the brain and extremities. 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). You may be a candidate for hybrid aorta surgery if you have:

  • A chronic condition like heart disease
  • Advanced aortic disease
  • Undergone aortic surgery previously

Hybrid aorta surgery lets cardiac surgeons minimize risk by using both surgical and catheter-based procedures to provide a lifesaving treatment option for high-risk patients. Using this approach, your surgeon performs aorta repair in two stages:

Stage One: Open Surgery

A specially trained cardiac anesthesiologist gives you medicine that puts you into a deep sleep during the operation so you won’t feel pain. Next, 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 reestablished.
  • Closes the incision and, if performed in a single operation, proceeds to the second stage.

Stage Two: Endovascular Surgery

In the same operating suite, 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.

Works with the anesthesiologist to help you regain consciousness.

Within the next few weeks you will return for imaging scans to ensure the graft is in place and working properly. Your surgeon will ask you to return for follow-up imaging tests every six to 12 months.

Hybrid Elephant Trunk Procedure

Another two-stage procedure helps patients with extensive aneurysms. These aneurysms exist in the rising, curving part of the aorta (ascending aorta and aortic arch) and downward parts of the aorta (descending aorta). Your doctor may choose to do this procedure in several steps, rather than complete both parts in one day. To perform this procedure your surgeon:

  • Uses a chest incision to replace the ascending aorta and arch with a synthetic graft. 
  • Places a second graft in the descending aorta without attaching it at the far end.
  • Uses a catheter to place an additional graft into the descending aorta, which he or she then connects to the graft placed earlier, completing the repair.

Benefits of Hybrid Aorta Surgery 

By combining an endovascular procedure with open-chest surgery, patients spend less time under anesthesia and may experience other benefits such as:

  • Shorter surgery time
  • Avoiding the use of a heart bypass machine
  • Avoiding a large chest incision
  • Faster recovery

Cardiac Rehabilitation after Hybrid Aorta Arch Surgery

After hybrid aorta surgery, you may need cardiac rehabilitation. A team of specialists work with you in an outpatient setting to support your recovery. Cardiac rehab includes exercise, nutrition, education and support. 

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