What is Aortic Surgery?
The aorta is the largest artery in the body, which carries blood from the heart and extends down through the abdomen. The aortic valve is present between the aorta and the lower chamber of the heart on the left side. It opens up to allow blood flow out of the heart and then closes to prevent backward flow of the blood into the heart. Aortic valve diseases include aortic valve regurgitation (aortic valve does not close properly, resulting in back flow of blood into the heart) and aortic stenosis (narrowing of the aortic valve, which results in restriction of blood flow).
The aortic valve defect may be present at birth or can be acquired at a later stage in life. Acquired aortic valve diseases occur because of structural changes in the valve which can be caused by rheumatic fever, infectious endocarditis, and aortic valve degeneration. Other causes include hypertension, tumors, radiation exposure, heart attack and connective tissue disorders.
The early symptoms of aortic valve diseases include fatigue, swelling of ankles, palpitation (irregular heartbeat), fainting, weakness, chest pain, and shortness of breath.
Aortic surgery is done to repair the enlarged aorta (aortic aneurysm), the aortic valve, the holes in aortic valves and to replace the aortic valves.
Aortic valve repair – It is done to treat leaking valves. Bicuspid aortic valve is repaired by reshaping the leaflets of the aortic valve such that the valve opens and closes completely.
Aortic aneurysm – Aortic aneurysm is the enlarged portion of the ascending region of the aorta. If the aorta is enlarged by 4 or 5 cm in diameter, it is replaced at the time of aortic valve repair.
Repair of tears of valve or holes – The surgeon sews the tears or holes on the valve leaflets with tissue patches.
Aortic valve replacement – Your surgeon removes the damaged aortic valve and replaces it with either mechanical (plastic, carbon, or metal), biological valve (from animal tissues), or human donated valve.
Minimal invasive surgery involves using endovascular techniques to place stent grafts within the aortic lumen to divert blood flow.
Several techniques that are used in minimal invasive surgery or keyhole surgery are laparoscopy, endoscopy, percutaneous surgery, or robot-assisted surgery.
In the endoscopic technique, the surgeon makes incisions in the chest and inserts a special instrument, the endoscope, through one of the incisions. This instrument has a camera attached to one end and the other end is connected to a large screen that helps to view the surgery better, and creates space for the surgeon to work. In robot-assisted surgery, your surgeon makes an incision on the chest and uses a computer to control the surgery with the help of 3D images.
In the minimal invasive surgery, your surgeon will make a few incisions on your sternum (breast bone) region in the chest. Through one of the incision, a special instrument is inserted. Through other incisions, surgical instruments are inserted and the diseased valve is removed, repaired, or replaced with the new valves.
Some of the risks associated with minimal invasive surgery are bleeding, blood clotting, breathing problems, and infection to the lungs, kidney, and chest or heart valves. Some other risks associated with surgery are damage to the nearby organs, nerves, or bones, heart attack, irregular heartbeat, and infection of the new valve.
Minimally invasive surgery has certain advantages over open surgery which are as follows:
Faster recovery because of smaller incisions
Minimal blood loss during the surgery
Length of the hospital stay is minimal (1 or 2 days)
Duration of the surgery is comparatively less than open surgery
Less pain, less scars, and less risk of wound infection
Aortic aneurysm is a condition characterized by an abnormal ballooning or bulging of a section of the aorta due to weakness in the wall of the blood vessel. The aorta is the main blood vessel that carries oxygenated blood from the heart to the different parts of the body. An aneurysm can develop anywhere along the course of the aorta.
Aneurysms that occur in the section of the aorta that passes through the abdomen are called abdominal aneurysms.
Aneurysms that occur in the part of the aorta that passes through the chest are called thoracic aortic aneurysms.
Surgical aneurysm repair is usually recommended if conservative measures fail to relieve the symptoms of aortic aneurysm or there is a risk of rupture due to the large size of the aneurysm.
During aortic aneurysm surgery, the aneurysm is exposed through dissection of the chest. A heart-lung machine is connected to the patient's body to maintain blood circulation during the surgery. At the same time clamps are placed on the aorta, above and below the aneurysm, and the damaged portion of the aorta is removed and is replaced with a synthetic tube or graft. Permanent wire sutures are used to join the breast bone or the sternum, which was dissected to approach the aorta. The skin and muscle is closed with dissolving sutures.
Stent graft procedure may be used to repair an aortic aneurysm in patients at high risk from surgery. During the procedure, a stent graft is placed inside the diseased portion of the aorta to help protect the aneurysm from rupturing.
After the surgical repair of the aneurysm, patients are advised certain lifestyle changes, such as abstinence from smoking, avoid heavy lifting, and blood pressure control, to improve their condition.