Aortic Dissection Repair

What is an aortic dissection?

An aortic dissection is a tear (dissection) in the wall of the body’s main artery (aorta). The aorta sends blood from your heart to the rest of your body. A tear causes blood to get in between the aorta’s 3 layers. This reduces the amount of oxygen and nutrients that can get to your body’s organs.

Aortic dissection is a medical emergency. Early diagnosis and treatment are important.

Over time, the tear can affect your brain, lungs, arms, legs, and heart. This depends on where along your aorta the tear occurs. Treatment also depends on where the tear is located. You will need surgery if the tear is on the ascending aorta. This is the part of the aorta that goes up through your chest toward your head.

Things that make it more likely to have an aortic dissection include:

• High blood pressure

• Injury from an accident

• Hereditary conditions that are passed down in families

• Structural heart problems

• Smoking

Why might I need an aortic dissection repair?

An aortic dissection can be life-threatening if it's on the ascending aorta. This is the part of the aorta that goes up through your chest toward your head. A surgeon must repair this as soon as possible.

There are 2 possible surgery methods for aortic dissection repair. The first is standard open-heart surgery. The second is less-invasive endovascular surgery. This may be advised if you aren’t strong enough for open-heart surgery. It may also be advised if the dissection is in your descending aorta. This is the part of your aorta that goes down through your chest and belly. But not all hospitals offer this method.

What are the risks of aortic dissection repair?

As with any procedure, problems can occur. Some possible complications may include:

• Stroke

• Heart attack

• Lung infections

• Bleeding

• Kidney failure

• Liver failure

• Paralysis

• Risks from anesthesia

• Death

You may have other risks depending on your health condition. Discuss any concerns with your healthcare provider before the procedure.

How do I get ready for aortic dissection repair?

If you need emergency surgery for an aortic dissection, you won’t be able to get ready in advance.

But if possible, before you are given medicine to put to you to sleep (general anesthesia), tell your healthcare provider:

• If you are allergic to any medicines

• If you have any loose teeth, bridges, crowns, or other types of dental work

• About all the medicines you take. This includes both over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements. Some could cause too much bleeding or other problems during surgery.

Your provider may have other instructions for you based on your health condition.

What happens during aortic dissection repair?

Surgery to repair an aortic dissection is very complicated. Your doctor can explain what to expect for your surgery. You will be given general anesthesia to prevent pain and put you to sleep during the procedure.

A healthcare provider will carefully watch your heart rate, blood pressure, and other vital signs during the procedure.

For a traditional open-heart surgery

• Your surgeon will make a cut (incision) in your chest or belly (abdomen). The exact spot will depend on where your dissection is located.

• A heart bypass machine will take over pumping blood around your heart and lungs.

• Once your surgeon has found the tear, he or she will use man-made (synthetic) grafts to replace the damaged parts of the aorta. If your aortic valve is damaged, your surgeon may also put in a replacement valve.

• When your surgeon has made all of the repairs, he or she will remove the heart bypass machine and close your incision.

For the endovascular method

• Your surgeon will attach a synthetic graft to the end of a tube (catheter). The graft is made of metal and polyester. Your surgeon will place the catheter into an artery in your leg.

• Using X-ray images as a guide, the surgeon will thread the graft through your artery, to the affected part of the aorta for the repair. X-ray dye (contrast medium) may be used to find the best placement of the graft and its correct position. 

• Your surgeon will remove the catheter. They will close the incision and put a small bandage on the wound.

What happens after aortic dissection repair?

In the hospital

You may need at least a month to recover from your surgery. 

You will be in the hospital for about the first week. 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.

Plan to have someone drive you home. It may not be safe for you to start driving right away. Ask your provider when you can drive again.

At home

If you had 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.

You will likely have to take blood pressure medicine. High blood pressure puts stress on the incision wall and on your heart.

If your surgery included a valve replacement, your healthcare provider may also give you blood-thinning medicine to reduce your risk for blood clots.

Recovery time for endovascular surgery is often shorter. But complications can still occur. These may include blood leaking from the graft. You may need to follow up with your healthcare provider every 6 months.

After an aortic dissection repair, you’ll need to be careful when doing strenuous physical activities and sports. These activities can put pressure on your aortic wall. This could increase your risk for another aortic injury. Mild to moderate exercise is often OK. But always talk with your healthcare provider before starting any exercise program. Ask your provider what activities are safe for you and when it's safe to begin.

If you smoke, stop smoking as soon as possible. This will give you a better chance for a successful recovery from surgery and improve your overall health.

Ask your healthcare provider what types of foods to eat and what types of foods to not eat. The recommended diet will depend on all of your healthcare needs.

Keep taking your medicines as prescribed.

A follow-up appointment will be made to monitor how you are healing and recovering from the procedure.

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, or as directed by your provider

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would  happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much will you have to pay for the test or procedure