Frequently Asked Questions
What is the aorta?
The aorta is the main blood vessel channeling blood from the heart to the body. The aorta has several major branches in the chest and abdomen.
What is an aneurysm?
An aneurysm is described in many different ways. Sometimes it is described as a doubling in size ie from 2cm to 4cm. However large people have large blood vessels and small people have small blood vessels.
Sometimes aneurysms are smooth and equal or symmetrical and are called fusiform while others are an odd shape and asymmetrical and called saccular.
On occasions aneurysms may result from a partial rupture and therefore do not involve all the layers of the wall and are called pseudoaneurysms.
When aneurysms are infected they are called mycotic aneuryms.
What is a dissection?
A dissection is a tear in the wall of the aorta. The split results in a 'double barrelled' aorta with two passages called the true lumen and the false lumen.
When the dissection is in the ascending aorta it is called a Type A dissection and usually emergency surgery is arranged. A dissection in the descending aorta is called a type B dissection and this may be managed with blood pressure control or on occasions a stent of surgery.
Acute Type A aortic dissection
Acute Type B aortic dissection
Will I need surgery?
Sometimes it is clear when surgery is needed such as when causing symptoms (pain or breathlessness) or when there is a tear in the aorta or a contained rupture.
In the absence of such factors, we generally use a guide a diameter of 5.5cm for surgery. This cut-off may be lowered in certain patients such as those with “bicuspid aortic valve”, Marfan Syndrome, Lowis Dietz Syndrome or EDS.
In addition, if you need surgery on other parts of your heart such at the aortic valve, mitral valve coronary arteries, you may be offered surgery on your aorta if it is greater than 4cm.
Why do I need surgery?
Surgery to replace the diseased aorta is needed to prevent a tear or “dissection” or rupture which is life threatening.
What will the operation involve?
Usually aortic operations are performed through the breast bone or between the ribs on the left side. Operations mostly involve the use of the heart lung machine and often take the entire day.
- Replacement of ascending aorta
- Replacement of aortic root
- Replacement of aortic arch and frozen elephant trunk
- Replacement of thoracoabdominal aorta
What is staging?
Often it is not possible to repair the entire aorta in one operation. In some patients, the first part of the aorta may be replaced through the breast bone and then following a period of recovery, other parts of the aorta may be replaced through the ribs and abdomen on the left side. This is called staging.
On occasions, some patients may require 2, 3 or 4 stages.
How long will my operation take?
Typically operations on the aorta take most of the day. Some cases may be quicker and some may last into the night.
How long will I be in hospital?
Depending on the size of the operation and the need for supportive care, patients may stay in intensive care for a variable length of time but at least one night. Your stay in the hospital will be at least 1 week but may be much longer depending on your care needs.
How long will my recovery take?
Recovery depends on the size of your operation and any complications you may have sustained. It is likely to be 6 weeks before you start to get near normal but it often takes 3 months and in some cases longer.
Why do I have wounds?
- Groin: Patients may have a wound in their groin which was used by the surgeon to attach the hear lung machine to blood vessels. You should report to your doctor if you feel any lumps in that region.
- Shoulder: Patients may have a wound on the right or left side just under the collar bone. This allows the surgeon access to an artery to attach patients to the heart lung machine.
- Ribs: Patients may have a small wound by the left breast which will have been used to help attach the heart to the heart lung machine. Other patients may have a large wound between the ribs on the left side of the chest down onto the abdomen. This will have allowed the surgeon to replace the aorta.
Why do I have a horse voice?
The nerve to the voice box courses close to the aorta in the chest. Sometimes the nerve may be bruised or injured during surgery. This may cause a horse voice.
Often simple exercises will suffice and your voice will recovery, although this may take several months.
If insufficient recovery occurs, the Ear Nose and Throat Surgeons may be able to improve the condition.
How long until I can drive?
Will I need follow-up?
You will need life long follow-up with scans and this may occur at LHCH or with your referring Cardiologist.
Will I still need tablets?
Yes, you are very likely to be on a number of drugs in the long term.
Is LHCH the best hospital to have my surgery?
LHCH is the largest specialised thoracic aortic centre in the UK with outcomes equivalent to any major centre worldwide.
What complications may I have?
Complications may occur following your operation and your surgeon will talk you through what they are and what the risks are for you.
Will I get back to normal or better?
If you had symptoms related to the aneurysm then hopefully, in time, these will be improved.
Some patients have few, if any, symptoms and undergo extensive surgery to prolong life. Some patients will achieve a 'new and different normal' but will have the knowledge their disease has been treated.