At Mount Sinai Heart, when we are deciding whether or not to treat your aortic aneurysm with surgery, we look at many factors including your age and overall health, as well as the aneurysm, its rate of growth, and any symptoms you may be experiencing. We perform surgery when the chances of rupture exceed the risks of the procedure, or if you are experiencing pain or other symptoms of compromised blood flow. We may advise early intervention, potentially including surgery, if you have an aneurysm of the ascending aortaor aortic root.
Our cardiac surgeons have extensive experience repairing aortic aneurysms, with outstanding results and very low complication rates. With our seasoned team of surgeons, perfusionists, anesthesiologists, and nurses, we provide all the elements needed to safely treat and care for patients with aortic aneurysms.
We often perform aortic surgery using a stent graft, which is a fabric tube with metal wire supports. This allows us to reinforce your aorta wall and prevent the damaged area from rupturing. We make a small incision in your groin and use a catheter to guide an endovascular stent graft through your blood vessels to the site of the aneurysm. The most common surgical procedures are:
- Aortic Root Replacement, also called a modified Bentall procedure, is what we typically use to treat aneurysmal disease of the aortic root, aortic root abscess, and acute and chronic aortic dissections. At Mount Sinai Heart, we use mechanical or bioprosthetic (made of bovine or porcine material) valve conduits, which are particularly long-lasting).
- Aortic Arch Replacement, also known as a trifurcated graft technique or elephant trunk stage I, is appropriate if you have aneurysmal disease of the aortic arch, mycotic (infected) aneurysm, chronic atheroembolism, or chronic aortic dissection.
- Distal Aortic Arch and/or Descending Aorta Replacement (elephant trunk stage II) is effectivefor aneurysmal disease of the descending aorta, chronic aortic dissection, coarctation, and hypoplasia.
- Thoracoabdominal Aorta Replacement is a procedure commonly performed for aneurysmal disease of the descending aorta, and chronic aortic dissection.
- Valve-Sparing Aortic Root Replacement (David or Yacoub procedure) is effective in treating aneurysmal disease of the ascending and aortic root, acute and chronic aortic dissections, bicuspid aortic valve disease, and Marfan’s disease. This procedure allows us to conserve the native aortic valve and avoid anticoagulation issues.
- Descending Aorta Replacement is an effective treatment for aneurysmal disease of the descending aorta, chronic aortic dissection, coarctation, and hypoplasia. We use endovascular stenting on aneurysmal disease of the aorta.
Frequently Asked Questions about Aortic Surgery
Before you undergo aortic surgery, it is important to understand the purpose of the procedure and when it is necessary. The following are some frequently asked questions about aortic surgery.
A: Most people with an aneurysm do not require surgery. The more we learn about heart disease, the more often we can diagnose aneurysms in time to treat them without surgery. This does not mean that fewer people are having aneurysms; we are just identifying them and providing therapy earlier and more often. It is important for an aortic surgeon to examine you to accurately measure the size of your aorta, usually with a magnetic resonance imaging or computerized tomography scan. We may also conduct an echocardiogram to assess the quality of the aortic valve.
Once we have this information, we will develop a treatment plan. This plan often includes certain lifestyle changes, such as stress management, tighter blood pressure control, and a limitation on the amount of straining (including reduction in weight-lifting and control of constipation). The treatment plan may or may not include surgery.
In general, we recommend surgical interventions for patients who have:
- Type A (ascending) aortic dissection, which is an emergency issue
- Ascending aortic diameter less than 4.5 cm in patients with Marfan syndrome or other connective-tissue disorders
- Ascending aortic diameter less than 5.0 to 5.5 cm in patients without Marfan syndrome
- Descending and thoracoabdominal atherosclerotic aortic aneurysm diameter less than 6 cm, or Type B aortic dissection complicated by impaired blood flow, rupture, or rapid expansion
- Dissecting descending thoracic aortic aneurysm diameter greater than 5.0 cm
- Expansion rate greater than 1 cm per year
A: An elective procedure allows you to research and choose your surgeon. It enables you to prepare yourself psychologically for the procedure and to feel a sense of control over your own destiny. We can pick a date that works for you and can provide information to your loved ones. The primary goal of an elective procedure is to reduce the risk of aneurysm rupture.
In contrast, an emergent aortic procedure is generally performed at the nearest hospital by an available surgeon and, typically, as soon as possible after your arrival to the emergency room. In emergency situations, the primary goal is to save your life.
A: It is rare that an aorta busts while you‘re waiting for surgery. But you can reduce your risk by reducing your stress level and controlling your blood pressure. There are several ways to lower your blood pressure including:
- Taking your blood pressure medication.
- Avoiding physical strain (such as moving furniture or taking the air conditioner out of the wall by yourself). This also includes weight lifting for exercise.
- Trying to avoid losing your temper.