At NYU Langone, surgeons may manage an aortic dissection with a procedure designed to repair or replace tissue in the wall of the aorta that’s been damaged by the tear.
Our surgeons use one of two techniques to help heal or repair an aortic dissection: endovascular surgery or open heart surgery. During endovascular surgery, which is minimally invasive, surgeons use small incisions to place a stent that allows the dissection to heal. Depending on where the dissection is located, open heart surgery may be used to surgically repair the tear.
Your doctor may recommend endovascular surgery for acute type B dissections that require immediate treatment and for some chronic dissections, depending on the nature of the dissection and where it occurs.
In this procedure, the surgeon makes small incisions in the groin to access the femoral artery in the leg, which allows the doctor to reach the aorta. If necessary, small incisions can be made in the chest instead of the groin.
Your surgeon advances a thin wire through the artery to the area near the aortic dissection, always staying within the true lumen, or natural passageway, of the aorta. The surgeon fits a thin tube called a sheath over the wire, slides it to the location of the dissection, and withdraws the wire. He or she then guides a stent graft, a fabric tube covered with a metal mesh, through the sheath to the dissection. The surgeon expands the stent graft to fit the diameter of the aorta.
The stent supports the aorta, allowing it to heal by cutting off the blood flow to the false lumen, which is a new channel for blood flow that was created by the tear in the aortic wall. It also reinforces the aorta and can therefore prevent an aortic aneurysm, or bulging of the aortic wall, from developing in the weakened aorta.
Sometimes, the surgeon uses a fenestrated stent graft, which is customized to fit the person’s aorta. The stent has specifically placed holes, or fenestrations, that allow blood to flow to the arteries that lead to certain organs, such as the kidneys. This device allows the surgeon to repair the aorta without affecting blood flow, even if the dissection is located near important arterial branches that supply blood to vital organs.
Recovery from endovascular surgery is significantly quicker than that from open heart surgery. You can expect to remain in the hospital for two to three days after surgery. Because your aorta and heart need rest in order to heal, your doctor may recommend that you refrain from driving and lifting anything heavier than 10 pounds for 10 days after surgery.
Type A aortic dissections that are located in the ascending aorta that exits the heart typically require emergency open heart surgery. This is because the dissection can split open, or “unzip,” the aorta. This can cause bleeding into the pericardium, the sac-like membrane that envelops the heart, or into the abdomen. This bleeding can lead to cardiac tamponade, a potentially fatal condition in which the blood accumulating in the pericardium puts pressure on the heart, preventing it from working properly.
In open heart surgery, the surgeon makes a large incision in the chest and opens the sternum, or breastbone, with surgical tools. Then he or she sutures, or sews together, the flap, called a septum, which is the partition between the layers of the aortic wall created by the dissection.
Sections of the aorta are replaced with a synthetic material called Dacron®, which usually lasts a lifetime. Before the procedure, surgeons give you a nutrient-rich solution intravenously that safely slows the heart to allow for surgery.
Because open heart surgery is a complex procedure, you can expect to remain in the intensive care unit for several days after surgery so your doctor can monitor your recovery.
Stents may also be implanted during open surgery to repair type A aortic dissections.
After you return home, your doctor may advise you not to drive for 1 to 2 weeks and to avoid lifting anything heavier than 10 pounds for 4 to 6 weeks. This is because your aorta and heart require rest and time to heal.
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