Aortic Arch Surgery
Background
The aorta is the large artery that leaves the heart and provides oxygen-rich blood throughout the body. It first travels upwards, before bending backward (the arch) and downwards to supply the lower parts of the body. The branches of the arch supply blood to the brain, head, and arms.
Many conditions can cause the aorta to dilate (widen), dissect (tear), or rupture (break). These are often life-threatening and require emergency surgery to repair them.
The conditions that can lead to this include atherosclerosis (fat and calcium buildup in the arteries), hypertension (high blood pressure), genetic conditions (such as Marfan Syndrome), connective tissue disorders (such as Ehler-Danlos disorder, scleroderma) and direct trauma.
About the surgery
First, the heart and aorta are accessed by dividing the sternum (breastbone). Then the patient is put on the heart-lung machine and the heart is stopped. The circulation through the aortic arch must then be stopped so that the diseased segment can be removed, and a synthetic (man-made) replacement graft inserted.
Since the circulation is stopped during the repair, a number of precautions are taken to prevent brain injury. The patient's temperature is cooled down to between 18-28 °C (normally about 37 °C), which reduces the activity of cells in the brain and body to a level low enough to prevent injury from occurring for a short time. A separate heart-lung machine circuit can be set up, which allows blood to flow to the brain whilst the circulation in the rest of the body is stopped (referred to as “selective antegrade cerebral perfusion”).
Depending on the extent of the aortic disease, a stent may also be inserted into the descending part of the aorta. Once the replacement graft has been sewn into place and all the artery branches reconnected, the circulation is started again and the patient is slowly rewarmed back to normal temperature.
Recovery period
Patients usually stay in the intensive care unit for two to three days for monitoring, and then moved to the ward for four to five days. Two to three tubes stay in the chest to drain fluid from around the heart and are usually removed one to three days after the surgery. Full recovery usually takes about two months. Your surgeon will provide specific guidelines for your recovery and return to work.
Risks of the surgery
As with all surgery, aortic arch surgery is associated with some risks. Your surgeon will calculate these risks specific to you, and discuss them with you.
All patients should consult their cardiothoracic surgeon for specific information about their medical condition and surgery.