A condition affecting the aortic root, ascending aorta, and/or aortic arch is operated on by a cardiac surgeon. During heart surgery, the diseased section of the aorta is replaced with a synthetic prosthesis.
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Surgery for an Aortic Aneurysm
A thoracic aortic aneurysm surgery involves surgically removing the enlarged section and replacing it with a synthetic vascular prosthesis. This prosthesis is made of polyester and comes in various sizes and shapes. The section of the aorta that needs to be replaced depends on the condition of the aortic valve, as well as the location and extent of the aneurysm.
Replacement of the Aortic Arch
If the aortic aneurysm is located in the aortic arch, the arch is either partially or fully replaced. If the aneurysm extends further along the aorta, a combined prosthesis is used. This consists of a synthetic graft and an endoprosthesis (a type of sealed stent).
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The end of this prosthesis extends into the descending aorta, giving it the name Frozen Elephant Trunk (FET). This technique allows treatment of the diseased section further down. If no immediate intervention is needed, the FET serves as a landing zone for a future procedure, enabling the placement of an additional prosthesis if the aneurysm extends into the thoracic and/or abdominal aorta.
Personalized External Support of the Aortic Root
The surgical technique PEARS stands for Personalized External Aortic Root Support. Using CT imaging and specialized software, a customized 3D prosthesis of the aortic root is created.
During surgery, the tailor-made prosthesis is placed around the dilated aortic root to reinforce and support the aortic wall, preventing further enlargement. In most cases, this procedure does not require the heart to be stopped.
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Procedure of the Surgery
Aortic surgery typically lasts between 4 to 6 hours and is performed under general anesthesia. The risk, duration, approach, and course of the procedure may vary depending on the nature of the aortic condition, underlying medical issues (e.g., hereditary disorders), and the urgency of the operation.
- To access the aorta, the surgeon partially or fully opens the sternum. This procedure is called a (mini-)sternotomy. In some cases, the surgery is performed through a thoracotomy (between the ribs).
- A heart-lung machine temporarily takes over the function of the heart and lungs, allowing the heart to be stopped so that work can be done on the aorta (and possibly the aortic valve).
- In aortic arch surgery, additional measures are necessary to protect the brain and body from oxygen deprivation, including cooling the body.
- A synthetic prosthesis is sutured onto a healthy section of the aorta.
- Afterward, the heart-lung machine is stopped, and your heart resumes beating.