Name of the Procedure:

Ascending Aorta Graft with Cardiopulmonary Bypass (includes Valve Suspension, when performed)

Summary

The ascending aorta graft procedure is a type of heart surgery where the damaged section of the ascending aorta is replaced with a synthetic graft. This surgery often uses a heart-lung machine (cardiopulmonary bypass) to maintain blood flow and oxygenation during the procedure. It may also involve the suspension or replacement of nearby heart valves, if necessary.

Purpose

The procedure addresses conditions like aortic aneurysms, aortic dissections, and severe aortic valve diseases. The goal is to prevent life-threatening complications such as aortic rupture, improve blood flow, and restore normal valve function if valve suspension is performed.

Indications

• Symptoms such as chest pain, back pain, or shortness of breath related to aortic conditions.
• Diagnosed aortic aneurysms or dissections.
• Severe aortic valve disease.
• Patients at high risk of aortic rupture or dissection based on diagnostic imaging.

Preparation

• Fasting for 8-12 hours before surgery.
• Adjustments to current medications as directed by the healthcare provider.
• Pre-operative diagnostic tests including echocardiograms, CT scans, and blood tests.
• Pre-surgical consultations with the surgical team and anesthesiologists.

Procedure Description

1. The patient is given general anesthesia to be fully asleep and pain-free during the surgery.
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 heart and lung functions.
4. The damaged section of the ascending aorta is removed and replaced with a synthetic graft.
5. If necessary, procedures to suspend or replace the aortic valve are performed.
6. Blood flow is restored through the heart and aorta, and the heart-lung machine is gradually disengaged.
7. The incision is closed, and the patient is moved to the recovery area.

Duration

The procedure typically takes around 4 to 6 hours, depending on complexity and any additional procedures required.

Setting

The procedure is performed in a hospital's operating room, specifically equipped for major cardiac surgeries.

Personnel

• Cardiothoracic Surgeon
• Surgical Assistants
• Anesthesiologist
• Perfusionist (operates the cardiopulmonary bypass machine)
• Surgical Nurses
• Post-operative Care Team

Risks and Complications

• Common risks: bleeding, infection, arrhythmias, and respiratory complications.
• Rare risks: stroke, heart attack, graft failure, or kidney failure.
• Management: Close monitoring in the intensive care unit (ICU) and immediate intervention if complications arise.

Benefits

• Prevention of aortic rupture or dissection.
• Improved heart function and blood flow.
• Relief from symptoms associated with aortic aneurysms or valve diseases.
• Benefits are generally realized shortly after recovery and rehabilitation.

Recovery

• Initial ICU stay for 1-2 days for close monitoring.
• Total hospital stay may range from 5-10 days.
• Gradual return to normal activities over 4-6 weeks with physical restrictions.
• Follow-up appointments for progress evaluation and medication adjustments.

Alternatives

• Endovascular aortic repair (EVAR) for specific cases.
• Medications to manage symptoms and conditions, though not curative.
• Pros and cons: EVAR is less invasive but suitable only for certain aneurysms; medications control symptoms but do not address the structural problem.

Patient Experience

• During: Under general anesthesia, the patient will not feel pain or be aware of the surgery.
• After: Postoperative pain management with medications, possible discomfort at the incision site, and gradual improvement in symptoms. Pain relief and comfort measures are provided to ensure a smoother recovery process.