33858 Ascending aorta graft, with cardiopulmonary bypass, includes valve suspension, when performed; for aortic dissection

Name of the Procedure:

Ascending Aorta Graft with Cardiopulmonary Bypass, includes valve suspension, when performed for aortic dissection

Summary

The ascending aorta graft procedure is a type of open-heart surgery performed to replace part of the ascending aorta, the large artery that carries blood from the heart to the rest of the body. This surgery often involves the use of a heart-lung machine (cardiopulmonary bypass) and may include the suspension or repair of a heart valve if necessary. It's typically performed to address aortic dissection, a serious condition where there is a tear in the wall of the aorta.

Purpose

The procedure addresses an aortic dissection, a potentially life-threatening condition characterized by a tear in the aorta’s inner layer. The goals are to repair the damaged aorta, prevent further tearing or rupture, restore normal blood flow, and prevent complications such as heart valve damage or organ failure.

Indications

• Severe chest pain radiating to the back
• Sudden onset of a tearing or ripping sensation in the chest
• Signs of cardiovascular collapse (e.g., low blood pressure, fainting)
• Diagnostic imaging (e.g., CT scan, MRI) confirming an aortic dissection
• Risk factors such as Marfan syndrome, hypertension, or previous cardiovascular surgery

Preparation

• Fasting for at least 8 hours before the surgery
• Preoperative blood tests, imaging studies, and a heart evaluation (echo or cardiac catheterization)
• Review of current medications; some may need to be adjusted or stopped
• Discussion of the procedure, risks, and benefits with the surgical team

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the chest to access the heart and aorta.
3. The patient is connected to a cardiopulmonary bypass machine to take over the heart and lung functions during the procedure.
4. The damaged section of the ascending aorta is removed.
5. A synthetic graft is sewn into place to replace the damaged aorta.
6. If necessary, the aortic valve may be repaired or suspended to ensure proper functionality.
7. Once the graft is in place, the heart is allowed to resume its function, and the patient is gradually weaned off the bypass machine.
8. The incision is closed, and the patient is taken to the intensive care unit (ICU) for monitoring.

Duration

The procedure typically takes between 4 to 6 hours.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (to operate the cardiopulmonary bypass machine)
• Intensive care unit (ICU) staff for postoperative care

Risks and Complications

• Bleeding
• Infection
• Stroke
• Heart attack
• Kidney failure
• Complications from the anesthesia
• Graft leakage or failure
• Prolonged recovery and the need for additional surgeries

Benefits

• Stabilizes the aorta and prevents further tearing or rupture
• Restores normal blood flow
• Reduces symptoms such as severe pain and risk of cardiovascular collapse
• Improves long-term survival rates for patients with aortic dissection

Recovery

• ICU stay for close monitoring (typically 1-2 days)
• Hospital stay for additional recovery (usually 5-10 days)
• Gradual return to normal activities over 6 to 8 weeks
• Follow-up appointments to monitor healing and heart function
• Possible participation in cardiac rehabilitation

Alternatives

• Medical management with medications (only for patients unfit for surgery)
  • Pros: Non-invasive
  • Cons: Less effective for severe cases and may not be curative
• Endovascular stent grafting (minimally invasive alternative for some cases)
  • Pros: Shorter recovery time, less invasive
  • Cons: Not suitable for all patients or all types of dissections

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Postoperatively, patients may experience pain and discomfort, which will be managed with pain medications. Patients can expect to have tubes and monitoring equipment attached in the ICU, and will gradually regain mobility and strength as they recover. Proper pain management, physical therapy, and follow-up care are crucial for a successful recovery.