Surgical   Repair of  Thoracic Aortic Aneurysms (TAA)

This procedure requires stopping the flow of blood through the aorta while the graft is being put into place. Surgery to repair an aortic aneurysm tends to become more challenging as the vessel nears the heart. If an aneurysm occurs in the ascending aorta, the heart-lung machine has to be used during graft replacement. If the aortic heart valve is also leaking, a heart surgeon may need to repair or replace it. During replacement of the ascending aorta, the coronary arteries may need to be detached. In that case, they can either be reimplanted directly into the synthetic graft, or they can be bypassed and the bypass graft sewn to the synthetic vascular graft.

Open surgical repair is typically performed under general anesthesia and takes about 4 hours to complete. Patients usually spend some time in the intensive care unit (ICU) and another several days in the hospital for early recovery. Depending on how quickly your body heals and any other associated health issues, hospitalization and recovery time may take about 3 to 6 months.

Patients who undergo elective surgery for aneurysms of the thoracic aorta have about a 90 percent chance of surviving the procedure, but the risk can be somewhat lower or higher depending on the exact circumstances, such as age, other medical conditions, and so forth. Most patients do well after the surgery and have about a 70 percent to 80 percent chance ten years later of being free of additional problems related to that aneurysm surgery. Sometimes more than one portion of the aorta is affected by the aneurysm. Some aortic aneurysms involve portions of the aorta in both the chest and the abdomen. These are called thoracoabdominal aortic aneurysms. When these aneurysms are replaced with synthetic grafts, the many arteries that branch off the aorta in that area will usually be sewn back onto the synthetic graft.

What Are the Risks of Open Surgery?

Repairing an aneurysm surgically is a complicated process that requires an extended stay in the intensive care unit as well as a prolonged hospital stay. Complications associated with open surgery include, but are not limited to the following:

1. Neurological complications (for example, stroke or paraplegia)
2. Cardiopulmonary complications (for example, heart attack)
3. Wound healing complications
4. Kidney failure
5. Multi-system organ failure
6. Infection
7. Fever
8. Shock
9. Sexual dysfunction
10. Death

Currently, medical management and open surgical repair are standard of care for thoracic aortic aneurysm and are proven medical therapies. However, both therapies have their limitations. Medical management does not fix the aneurysm, just reduces the stresses (i.e., blood flow pressure) on the aneurysm. Although open surgical repair is a proven treatment, not all patients can tolerate this major operation. Endovascular repair  is a relatively new procedure for the treatment of thoracic aortic aneurysm.