Aortic hemiarch graft including isolation and control of the arch vessels, beveled open distal aortic anastomosis extending under one or more of the arch vessels, and total circulatory arrest or isolated cerebral perfusion (List separately in addition to
CPT4 code
Name of the Procedure:
Aortic Hemiarch Graft Common names:
- Aortic Hemiarch Replacement
- Beveled Open Distal Aortic Anastomosis
Summary
The aortic hemiarch graft is a surgical procedure to repair and replace the damaged portion of the aortic arch, specifically addressing areas extending under one or more arch vessels. This involves temporarily halting blood circulation and ensuring the brain receives adequate blood supply through isolated cerebral perfusion.
Purpose
The primary goal of the procedure is to restore proper blood flow through the aorta, thereby preventing or treating life-threatening conditions such as aortic aneurysms or dissections. The procedure aims to provide a durable repair that prevents rupture and maintains the integrity of the aorta.
Indications
- Aortic aneurysm involving the arch
- Acute or chronic aortic dissection
- Traumatic aortic injury
- Connective tissue disorders affecting the aorta (e.g., Marfan syndrome)
- Symptomatic artery obstruction in the aortic arch region
Preparation
- Patients may need to fast for 8-12 hours before surgery.
- Adjustments or temporary cessation of certain medications (e.g., blood thinners).
- Comprehensive pre-operative assessments, including imaging studies (CT or MRI scans) of the aorta, blood tests, and cardiac evaluations.
Procedure Description
- The patient is placed under general anesthesia.
- A sterile surgical field is prepared.
- The surgeon makes an incision in the chest to access the aorta.
- Isolation and control of the arch vessels is performed to prevent blood flow to those vessels during surgery.
- Circulation is halted using total circulatory arrest or isolated cerebral perfusion to protect brain function.
- The damaged section of the aorta is identified and excised.
- A beveled open distal aortic anastomosis is created to ensure a seamless connection to the graft, extending under one or more of the arch vessels.
- A synthetic graft is sewn into place to replace the excised aortic segment.
- Blood flow is gradually restored, and the chest incision is closed.
Duration
The procedure generally takes between 4 to 8 hours, depending on complexity and patient-specific factors.
Setting
The surgery is performed in a hospital, typically in a specialized cardiovascular operating room equipped with advanced surgical and monitoring technologies.
Personnel
- Cardiovascular surgeon
- Anesthesiologist
- Surgical nurses
- Perfusionist
- Surgical technologists
Risks and Complications
- Bleeding
- Stroke
- Infection
- Heart attack
- Graft leakage or failure
- Spinal cord injury leading to paralysis
Benefits
- Stabilization and restoration of the aorta’s structure.
- Prevention of aneurysm rupture or dissection progression.
- Improved blood flow to critical areas of the body, including the brain.
- Increased lifespan and quality of life post-repair.
Recovery
- Intensive care monitoring post-surgery.
- Pain management with medications.
- Gradual reintroduction to normal activities over several weeks.
- Follow-up appointments to monitor graft function and overall recovery.
Alternatives
- Endovascular aortic repair (minimally invasive approach)
- Medications to manage symptoms (less effective for severe cases)
- Conservative monitoring (for very small or asymptomatic aneurysms)
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel anything. After the surgery, the patient might experience discomfort and pain at the incision site, managed with medication. Recovery involves a hospital stay for a few days to weeks, followed by gradual return to regular activities. Regular follow-up is essential to monitor the success of the repair and manage any complications.