About Aortic Dissection
An aortic dissection is a tear (dissection) in the wall of the body’s main artery, the aorta. This is caused by blood pumping against weakened aortic walls. One channel known as the true lumen feeds blood to most of the important branches of the aorta and is surrounded by the normal aortic lining. The second channel, called the false lumen, may only feed a few (if any) important branches. This is a very complicated situation which, if untreated, can lead to death. Dissections involving ascending aorta almost always require emergency open-heart surgery to prevent death.
The management of aortic dissection depends on its type i.e. type A or a type B tear. Type A aortic dissections are more common and more dangerous types. These involve the ascending part of the aorta or the aorta before the left subclavian artery. Type A aortic dissections mostly need surgery because with these treatment with just medications has a high rate of mortality. Type B aortic dissections involve the aorta after the left subclavian artery and can be managed just with medications and no surgery unless the patient develops complications that require more interventions, probably an endovascular repair which is less invasive.
Types of Aortic Dissection Repair Surgery
The goal of the aortic dissection repair surgery is to replace/repair the affected aorta. Surgeons replace the affected part of the aorta with a graft. So the diseased aorta is cut off and replaced with a synthetic tube.
There Are Two Types Of Aortic Dissection Repair Surgeries Done:
Open Aortic Dissection Repair Surgery
- The surgery involved in repairing an aortic dissection is very difficult and invasive. As has been stated before, type A dissections require immediate surgical repair.
- In the operating room, a cardiothoracic surgeon first performs a median sternotomy, a procedure in which a patient’s chest is opened.
- Then, the patient is placed on cardiopulmonary bypass. This means that a patient’s blood is routed around the heart and lungs through a machine, so that the body may still receive blood and oxygen while allowing surgeons to operate on the aorta. During this time, the bypass machine can cool the patient’s blood, which in turn cools the patient’s body and reduces its oxygen requirements. To operate on the aorta, the heart cannot be pumping. Cardioplegic solution, a nutrient-rich solution that slows down the heart, is injected into the heart. This solution greatly reduces its metabolic demands, allowing the heart to be nearly stopped during the procedure yet kept alive. Surgeons then inspect the aorta to look for the site of the tear that caused the dissection. In addition, they investigate the extent of the tear and determine if anything else, such as other vessels, may have been affected by the dissection.
- Surgeons suture together the layers of the aorta that were affected, closing the tear that dissected.
- The aorta is then reinforced with a graft–a synthetic material–that can be wrapped around the aorta. If necessary, graft may also be used to replace portions of the aorta. These grafts usually last an entire lifetime.
- The graft is then sutured in its place so that the blood flows through the graft. If the valve controlling the unidirectional flow of blood from the heart to the aorta is damaged, it is repaired or replaced.
- The heart is disconnected from the heart-lung machine and restarted. The breast bone is joined and the chest incision is closed.
Endovascular Aortic Dissection Repair Surgery
Stent grafting is a minimally invasive treatment for an aortic dissection. In this procedure, a cloth-covered stent graft is used to seal the tear in the aorta. One or more uncovered stents may be added to support and expand the true lumen in order to improve blood flow to your abdominal organs, pelvis and legs. The surgery is performed in the following steps:
- You will be sedated or be given general anesthesia.
- Once you are comfortable, a puncture will be made in a femoral artery. With the help of X-ray images, guide wires and a thin tube (catheter) are advanced through the artery to the dissection.
- Angiogram images of the aorta are taken to decide where the covered stent should be placed. The stent graft is then advanced into position.
- Confirming X-rays are taken. If needed, the covered stent is adjusted to form a seal. Additional angiogram images are taken to confirm whether the position and length of the covered stent is adequate or additional uncovered stents are needed. Intravascular ultrasound may also be used to assess progress.
- After all needed stents are in place, any wires or catheters are removed and access punctures or wounds are closed.
Recovery Period After Aortic Dissection Repair Surgery
- You may need at least 1 month to recover from your Aortic Dissection Repair Surgery.
- You will be in the hospital for about one to two weeks following aortic dissection repair. You will usually be in the intensive care unit (ICU) until your vital signs are stable. You will move to the regular nursing floor to continue your recovery before you go home. During your hospital stay, you may need medicines for nausea, pain, and discomfort.
- After an open-heart surgery, it may take a few months to fully regain your energy while your body is healing. Make sure you get good rest, and eat enough calories and nutrients to improve your energy.
- Recovery time for endovascular aortic dissection repair surgery is often shorter. But there can be problems. These may include blood leaking from the graft. You may need to follow up with your provider every 6 months.
As you heal, be sure to watch your incision for any problems. Call your provider if:
- Your incision becomes more sore, red, or swollen.
- There is drainage from the incision
- You have a fever of 100.4°F (38°C) or higher
In conclusion, the distinction between the two types is important, as it guides the management of the disease. Type A aortic dissection requires immediate surgery, to prevent death from stroke, heart attack, congestive heart failure, or bleeding. Type B aortic dissection is considered a medical condition that can be initially treated with aggressive control of blood pressure. Additional treatments are generally reserved for complications resulting from the tear.