Many patients will be referred to clinic for an opinion and not all will require surgery. We only plan surgery when the size of the aneurysm is such that the risks of rupture become significant. This is a complex decision process and specific to each patient. Your surgeon will talk you through the disease, options and risks of surgery. Sometimes surgery will involve a stent.
Multi-disciplinary Team (MDT)
- Frequently patients and their diseases are complex and will be discussed at a Multi-Disciplinary Team (MDT) involving surgeons, anaesthetists, intensivists and radiologists as well as other specialists involved in medical care of vascular patients
- When patients have complex diseases, especially in the presence of other conditions such as lung, kidney or heart problems, they will be assessed for fitness in the clinic. Elderly and or frail patients will also need assessment.
- Patients will be asked to undergo a number of tests. These include:
- Imaging is an important part of assessing your aorta.
- Assessing the status of the blood vessels of your heart is important in planning aortic surgery. The process may be understood by following this link:
- Assessing your lung function is an important part of your preoperative work-up.
Types of surgery
- We use devices which are commercially available called “Dacron Grafts” to replace the aorta.
- The replacements may be bought in different sizes, different lengths with and without branches and are made of a man made fabric (ie http://www.vascutek.com/about-us/).
- On occasions surgery may involve a “stent” which is most often a fabric covered rigid hollow tube mesh and sits within the aorta.
Your new valve
- If your valve is diseased it may be repaired or replaced.
- Options for replacements include a mechanical (ie http://www.medtronic.com/us-en/healthcare-professionals/products/cardiovascular/heart-valves-surgical/open-pivot-mechanical-heart-valve.html) or a biological valve (ie http://www.edwards.com/devices/heart-valves/aortic).
- Replacing the ascending portion of the aorta is the commonest operation performed and on occasions may be the main focus of the operation.
- Replacing the aortic root is a more complex procedure that involves removing all aortic tissue deep into the heart.
- In this procedure the valve is often replaced and the coronary arteries are re-implanted into the new aorta. In certain patients the valve may be preserved known as a “David or Yacoub valve sparing root repair”.
- Arch surgery is more complex and often involves a period of “deep hypothermic circulatory arrest” during which the patients body is cooled on the heart lung machine. Part or all of the aortic arch is replaced.
- On occasions a special graft is used attached to a stent called a frozen elephant trunk. This allows treatment of aortic disease far down into the descending aorta in one sitting.
- Sometimes a “conventional elephant trunk” may be left which is a short length of Dacron left hanging into the descending aorta which aides a second stage operation via a cut between the ribs.
- Thoracoabdominal aortic surgery is the most extensive and complex surgery offered. The surgery is performed via a cut between the ribs and onto the tummy. Your surgeon will go through the complexity of the surgery, the perioperative care and the risks of surgery and expected recovery.
- So-called “endovascular repair” may be suitable for certain selected patients and involves fabric covered mesh devices placed within the aorta to treat aneurysms. This is currently more commonly offered to patients with isolated aneuryms in the abdomen.