Aortic dissection repair is a surgical procedure performed to treat aortic dissection, a life-threatening condition in which there is a tear or rupture in the inner lining of the aorta, the main artery that carries oxygenated blood from the heart to the rest of the body.
When the aortic dissection involves the ascending aorta (the portion of the aorta that rises out of the heart) they require immediate surgical intervention and open-heart surgery. Dr.Nikhil says, “Ascending Aortic Dissection is a true cardiac surgical emergency. With a mortality rate of 1% per hour, 50% of patients with this diagnosis are dead in 48 hours!”.
The surgical procedure is known as Aortic Dissection Repair. In this procedure the patient is placed under general anesthesia, and their chest is opened through a sternotomy (incision in the chest). The patient is connected to a heart-lung machine to maintain blood circulation during the surgery. However the most challenging part of the procedure is when the surgeon replaces the damaged portion of the aorta with a synthetic graft, effectively replacing the torn segment. This is done under deep hypothermic circulatory arrest. In some cases, the surgeon may also repair or replace any damaged heart valves if necessary. Or an entire root replacement will have to be done called Bentall Procedure. After the repair, the patient is gradually weaned off the heart-lung machine, and the chest is closed.
When the Ascending Aorta and Arch are not involved immediate surgery is rarely needed. Medical treatment of blood pressure is key. In some patients Endovascular stenting might be indicated. The decision regarding which type of repair is necessary depends on the location, extent, and severity of the dissection, as well as the overall health and stability of the patient.
Aortic dissection repair is a complex surgical procedure that carries certain risks, including bleeding, infection, and complications related to anesthesia. The patient’s overall condition and the urgency of the repair will determine the surgical approach used. After the procedure, patients typically spend time in the intensive care unit for monitoring and are gradually moved to a regular hospital room as they recover.
Recovery following aortic dissection repair can be a lengthy process, and patients will require ongoing medical supervision to ensure that their condition stabilizes and that they can manage their cardiovascular health effectively. The specific treatment plan and post-operative care will be determined by the healthcare provider in consultation with the patient.