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What is involved in thoracic aortic aneurysm surgery?

Thoracic aortic aneurysm surgery would ideally be planned and scheduled with a cardiothoracic surgeon if a thoracic aortic aneurysm is detected before it tears or ruptures. The cardiothoracic surgeon likely will recommend replacement or stenting of the affected portion of the aorta with an artificial graft.

If the aneurysm is close to the aortic valve, or an ascending aortic aneurysm (located in the part of the aorta that exits the heart then travels up toward the neck), the valve may also have to be repaired or replaced through an incision on the front of the chest wall. This incision is called a median sternotomy and extends down the front of the chest, through the breastbone or sternum, which enables the cardiothoracic surgeon to see the heart and aorta.

Surgery on the aortic arch (the curve in the aorta after it leaves the heart and travels up toward the neck, then down into the chest toward the abdomen) is also usually done from an incision on the front of the chest wall. If the aneurysm involves the descending thoracic aorta (the part of the aorta after the curve in the neck which travels down toward the abdomen), an incision on the left side of the ribcage may be required.

This content originally appeared online in "The Patient Guide to Heart, Lung, and Esophageal Surgery" from the Society of Thoracic Surgery.
Thoracic aneurysm is a pathologic dilatation of the thoracic aorta. The abnormality may be present in the ascending part, the aortic arch or the descending part of the aorta. If this dilatation becomes significant (> than 5 cms in diameter) a repair is recommended to avoid the risk of a rupture which is a life threatening condition. Two approaches are nowadays available: the surgical and the endovascular one. The surgical approach involves the replacement of the dilated part of the aorta with a synthetic graft. It is an open-heart procedure involving general anesthesia and the use of a heart-lung machine to replace the function of the heart and the lungs while the surgeon fixes the aneurysm. Traditionally, it is done by cutting the whole breastbone (sternum) or through a side incision (thoracotomy) depending on the position of the aneurysm. The endovascular approach involves the insertion of a thoracic stent graft into the aneurysm through a small incision done in the leg artery (groin). This procedure can be done by general, regional or local anesthesia. Aneurysms of the descending aorta are repaired most commonly by this approach. The endovascular approach compared to the surgical one is related to decreased mortality, less blood loss and shortened hospital stay.

An aortic aneurysm is dilation, bulging or ballooning of a weakened part of the aortic artery wall. The normal pressure of blood from the pumping of the heart causes the weakened portion of the aorta to slowly stretch and bulge, leading to the formation of an aneurysm. The key to successful treatment of thoracic aortic aneurysm is careful monitoring and referral for surgical consultation to avoid rupture of the aneurysm, a medical emergency requiring immediate surgical intervention. Experts agree that aneurysms of greater than 5.5 cm in diameter should be evaluated for surgical repair because the risk of rupture increases with increasing size of the aneurysm.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.