Name of the Procedure:

Ascending Aorta Graft with Cardiopulmonary Bypass, Includes Valve Suspension, for Aortic Disease Other Than Dissection (e.g., Aneurysm)

Summary

This surgical procedure repairs or replaces a section of the ascending aorta, the large blood vessel leaving the heart, using a synthetic graft. It involves the use of a cardiopulmonary bypass machine to take over heart and lung functions during surgery and may include valve suspension if the aortic valve is affected. This procedure is typically performed to address aneurysms or other aortic diseases that are not dissections.

Purpose

The primary purpose of this procedure is to address conditions like aortic aneurysms, which are bulges in the wall of the aorta that can be life-threatening if they rupture. The goals are to prevent rupture, restore normal blood flow, and ensure the stability and proper functioning of the aortic valve when necessary.

Indications

• Aortic aneurysm in the ascending aorta
• Significant enlargement of the ascending aorta
• Risk factors for aortic rupture
• Symptoms such as chest pain, hoarseness, coughing, or difficulty breathing
• Presence of connective tissue disorders like Marfan syndrome that affect the aorta

Preparation

• Fasting for at least 8 hours prior to the procedure
• Medication adjustments as directed by the healthcare provider, including stopping certain blood thinners
• Pre-surgery diagnostic tests, including echocardiogram, CT scan, or MRI to assess the aortic condition
• Consultation with a cardiologist and anesthesiologist

Procedure Description

1. General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. An incision is made in the chest to access the heart and aorta.
3. The patient is connected to a cardiopulmonary bypass machine, which takes over the heart and lung functions.
4. The affected section of the ascending aorta is removed.
5. A synthetic graft is sewn into place to replace the removed aorta segment.
6. If the aortic valve is affected, valve suspension or repair is performed.
7. The heart is restarted, and the patient is gradually weaned off the bypass machine.
8. The chest incision is closed with sutures or staples.

Duration

The procedure typically takes 4 to 6 hours.

Setting

Conducted in a hospital surgical suite equipped for cardiac surgery.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (operates cardiopulmonary bypass machine)
• Cardiovascular technicians

Risks and Complications

• Bleeding
• Infection
• Stroke
• Myocardial infarction (heart attack)
• Kidney failure
• Graft leakage or malfunction
• Heart rhythm problems
• Respiratory issues
• Clotting issues leading to pulmonary embolism or deep vein thrombosis

Benefits

• Eliminates or significantly reduces the risk of aortic rupture
• Restores normal blood flow and aortic function
• Improves symptoms, if present
• Long-term durability of the synthetic graft

Recovery

• Hospital stay of 7 to 10 days, including intensive care for the first few days
• Pain management with medications
• Instructions on wound care and activity restrictions
• Follow-up appointments for monitoring and assessments
• Full recovery may take several weeks to months, with gradual resumption of normal activities

Alternatives

• Endovascular aneurysm repair (EVAR) for suitable cases
• Medical management for less severe aneurysms, including blood pressure control
• Surveillance with regular imaging tests for small or stable aneurysms

Patient Experience

• Pre-procedure anxiety, which can be managed with medications and reassurance
• Post-operative pain and discomfort managed with pain relief medication
• Fatigue and weakness during recovery, gradually improving over time
• Monitoring for any complications or signs of infection, with instructions provided for home care