How To Code Ascending Aortic Aneurysm Repair

This page contains the following sections:

When is surgical repair of an aortic aneurysm appropriate?
How is repair of an aortic aneurysm accomplished?
What are the risks and benefits of such surgery?
What is involved in a typical recovery?

When is surgical repair of an aortic aneurysm advisable?

Diagram of the human heart

If an aortic aneurysm—a bulge in the wall of your body's main artery—is larger than 2 inches (or 5.0 to 5.5 centimeters) in diameter, is growing fast, or is causing serious symptoms (such every bit pain or trouble breathing), it is appropriate to consider the possibility of surgical repair.

If you are diagnosed with an aneurysm, your surgeon will evaluate the specifics of your situation and help you lot weigh the risks of cardiac surgery against the risks of continuing to manage the disorder with medication and other nonsurgical treatments. If your aneurysm and its symptoms take non yet reached a betoken where surgery is indicated, you can enroll in our comprehensive, multidisciplinary aneurysm follow-up clinic; this will provide you lot with regular imaging of your aneurysm and assessment of your health status.

Should you and your surgeon decide the time is right for surgical repair, keep in heed that our cardiac surgeons have considerable expertise in all the proven options for the surgical repair of aneurysms.

How is repair of an aortic aneurysm accomplished?

There are a number of means to repair or supplant the portion of an aorta damaged by an aneurysm. Which option is used will depend on such factors as where your aneurysm is located (whether it'southward in your ascending aorta or aortic arch, for instance, or in your descending aorta), how big it is, and the overall state of your health. Your surgeon will determine which of the following procedures is most advisable in your detail situation:

Open-center surgery to repair an aortic aneurysm involves making a seven- to-10-inch incision over the middle of the sternum, or breastbone, and then dividing the sternum to allow access to the heart. In some cases a less invasive option, involving a slightly smaller sternal incision, is possible. In either instance, the bodily repair involves replacing the damaged portion of your aorta with a graft—a tube the same size equally your aorta, made of a durable bogus cloth such as Dacron, which is sutured, or sewn, into identify.
It will exist necessary to finish your heart from beating during the procedure, so the functioning can be performed on a motionless and anemic field; while your centre is stopped, a device known as a heart-lung featherbed automobile will have over your heart's function and maintain your circulation. Very occasionally, during complex operations involving replacement of a portion of the aorta, yous may also be put into a land known every bit hypothermic circulatory abort; this involves lowering your torso temperature to significantly slow your body's cellular action, permitting your claret menstruum to exist temporarily stopped. (The term "hypothermic" comes from Greek words significant "depression heat," while "circulatory arrest" ways your circulation is arrested, or stopped.) In other cases, a technique known as axillary cannulation (or the insertion of a drainage tube, known as a cannula, in an artery in your armpit, or axilla) tin let aortic replacement to be performed without hypothermic circulatory arrest; this advance may reduce the incidence of postoperative strokes and neurological deficits.

Endovascular surgery may exist an option for some patients. This minimally invasive process involves making a couple of tiny incisions (often but i to 2 inches) in blood vessels in your groin; inserting long, thin tubes known as a catheters through the vessels to the signal where your aneurysm is located; and then using X-ray guidance and long, thin instruments threaded through the catheters to identify a lilliputian mesh tube known as a stent graft inside the afflicted portion of the vessel. (The term "endovascular" comes from Greek and Latin words pregnant "within a vessel.")
In circumstances when information technology is appropriate, endovascular surgery can sometimes exist done with the patient under local rather than full general anesthesia; in addition, it usually does not crave hypothermic circulatory abort or utilize of a heart-lung featherbed machine. Since this approach avoids the need to open the breast at all, it commonly results in much faster healing.

Valve-sparing surgery can be considered for operations on the office of the aorta closest to the centre, the aortic root. This process involves replacement of but the damaged portion of the vessel, not of the aortic valve as well; it is thus advisable only for patients whose aortic valve is intact or repairable. The alternative is known as a composite graft, and it involves not only replacing the affected portion of the aorta but also replacing the aortic valve with a mechanical valve.

What are the risks and benefits of such surgery?

It is important to go along in mind that every medical selection involves a trade-off between risks and benefits—whether it is to undergo surgery, take medication, or fifty-fifty only carefully monitor a condition (an option known as "watchful waiting").

In the case of an aortic aneurysm, if you run into the criteria above (that is, your aneurysm is larger than two inches, growing fast or causing serious symptoms), deciding whether surgery is advisable involves balancing the risks involved in any eye surgery against the increasing likelihood that your aneurysm may rupture, or burst. Your risk of dying if y'all suffer a ruptured aortic aneurysm is between 50% and 75%.

The risks involved in surgery are far lower. A given patient's risk volition vary, depending on such factors equally historic period and overall health status, just the boilerplate mortality, or take a chance of death, from repair of an aortic aneurysm is about five%. Surgery to repair an aneurysm is as well associated with a 3% to 5% gamble of a blood clot that causes a serious stroke. And whatsoever surgical procedure involves a very small take a chance of other complications, such as infection.

Patients who smoke can reduce their risk of complications if they terminate smoking at to the lowest degree 2 to 4 weeks before their surgery (it is best not to quit immediately before having heart surgery, however, because when people stop smoking they often take short-term bronchorrhea, or excess secretions in their respiratory tract, which makes them cough a lot—and coughing a lot when you lot have just had heart surgery is not a adept thought).

The benefits of a successful repair are considerable. The overwhelming bulk of patients who undergo repair of a major aortic aneurysm, once they recover, experience better than they did before the performance, are able to exhale far better, and are able to resume any activities they wish to engage in.

What is involved in a typical recovery?

A typical open up-eye procedure takes from four to 6 hours, in some cases up to 8 hours; patients are then maintained under general anesthesia for an additional 4 to six hours. If their wound is healing well and there is no excess bleeding, they tin can emerge from anesthesia and accept their breathing tube removed. Most patients stay in the ICU until midday of the twenty-four hour period after their procedure; if they continue to practise well, the drainage tubes in their chest can then be removed and they can be moved to a regular hospital bed subsequently that day.

The typical hospital stay ranges from 7 to 10 days, in some cases upwardly to 14 days. At that point, the vast majority of patients are able to go home, with support from the visiting nurse service, though near fifteen% to 20% may demand to spend some time in a rehab facility for more than extensive rehabilitation. Afterwards discharge, patients are advised not to drive for almost three weeks and not to elevator anything heavier than 5 pounds for near 6 weeks. Beyond that point, they can resume whatever activities they wish to.

Patients tend to be surprised at how easy it is to control their pain. By the second day afterward their operation, nigh patients are comfortable without intravenous pain medication, taking but oral painkillers, and the overwhelming majority are discharged home on just Tylenol or Motrin.

In cases when minimally invasive surgery is advisable, both the length of the functioning and the recovery period are typically shorter (and much shorter in the instance of endovascular surgery).

Page reviewed on: Jun 26, 2018

Page reviewed past: Jock McCullough, MD