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What is aortic dissection surgery?

The aorta, the body's largest artery, extends upward from the top of the left ventricle of the heart (ascending thoracic aorta), then curves like a candy cane (aortic arch) downward (descending thoracic aorta) into the abdomen (abdominal aorta). The aorta delivers oxygenated blood to the rest of the body. The heart pumps blood out of the left ventricle, through the aortic valve, and into the aorta.

An aneurysm is a condition affecting the aorta in which the blood vessel may become enlarged beyond its normal size. In some cases, an aneurysm can cause an aortic dissection, which is a tear in the intima of the aorta that causes a false lumen (blood passageway). An ascending aortic dissection develops in the aorta closest to the heart and can result in stroke, heart attack, heart failure and cardiac tamponade; a descending aortic dissection is a tear in the descending aorta that travels down the aorta and may extend for its entire length.

Aortic dissection treatment includes a number of surgical options, from open surgery to minimally invasive procedures (endovascular). However, if the dissection involves the ascending aorta, emergency open-heart surgery is almost always required.

Our approach

Our approach to treating aortic aneurysms and dissections is rooted in preparation. We take pride in identifying the risk of aneurysm early so that we can take careful steps to prevent rupture. Once you’ve been diagnosed, we work diligently to understand your condition, anatomy and present risk factors so that we can craft the ideal course of action. Whenever possible, this course involves a minimally invasive procedure to limit the size of incisions, postoperative pain and recovery time. Our specialists are strategic and compassionate, putting your needs and your quality of life first.

Why it’s done

If not treated, aortic dissections can potentially be fatal, especially when involving the ascending aorta. If your aorta dilates over the years after the aneurysm and causes a thoracic or thoracoabdominal aortic aneurysm, surgery will be necessary.

Surgery is also necessary if:

  • Your aorta rapidly begins dilating
  • Your aorta ruptures or leaks
  • Certain parts of your aorta stop working or become further damaged
  • You experience sharp pains in your chest and back, even with healthy blood pressure and heart rate

If you are not a candidate for open-heart surgery, your surgeon may recommend endovascular surgery in its place. Endovascular surgery is also a popular treatment option for descending aortic dissection, which is not as life-threatening as a dissection in the ascending aorta.

What to expect

Prior to surgery, you’ll be given general anesthesia and positioned on your right side. An incision will be made on your left side, extending from your chest to your abdomen, so that your ribs can be spread and your aorta accessed.

You’ll be given medication to thin your blood and reduce your blood pressure for the surgery. Then, your surgeon will repair the aorta by opening it up and removing the dissection flap. Other branches of your aorta may need to be repaired as well, depending on the extent of the damage.

Recovery

Aortic dissection surgery recovery requires a postoperative stay in the intensive care unit (ICU). On average, you can expect to be in the hospital for about two weeks during the initial recovery from the surgery. After the hospital stay, you may need an additional one to two weeks at a rehabilitation facility to build your strength back up.

Many people lose appetite during the recovery, so be sure to eat regularly and stay hydrated. You should begin to feel normal again after three to four months.