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Home > Our Services > Conditions and Treatments > Heart, Lungs & Vascular Surgery > Aortic Surgery

Aortic Surgery








There are several forms of Aortic Surgery:


Open abdominal or open chest surgery: The standard treatment once Aortic Aneurysm reaches the need for surgery is the replacement of that portion of the aorta with and artificial graft. The graft, typically made from DacronTM, a material which doesn't wear out is sewn in place with a permanent suture material.


Endovascular surgery: Recent advancements have allowed aortic aneurysm to be repaired without major surgery resulting in less trauma to the aorta, less blood loss and fewer days in intensive care. The success of endovascular surgery has resulted in the development of similar techniques for the treatment of thoracic aortic aneurysms as well.


This procedure may not be for every person, although it usually benefits those who need surgery but are at high risk of complications due to pre-existing medical problems.


In endovascular surgery, a thin tube (catheter) is inserted into the blood vessel, usually an artery in the leg. Attached to the catheter, is a graft (stent-graft made of a polyester tube within a metal cylinder). The surgeon would then place the stent-graft where the aneurysm is using X-ray guidance.


The graft is expanded once it's in place. To prevent rupture of the aneurysm, the weakened section of the aorta is reinforced by the stent-graft. With the metal frame expanded like a spring, the wall of the aorta is held up. Blood now flows though the stent-graft as the blood supply is cut off the aneurysm.


Hybrid Elephant Trunk Procedure


For patients who have extensive aortic aneurysms involving both the ascending aorta and aortic arch, and the descending thoracic or thoracoabdominal aorta, the hybrid elephant trunk procedure is a commonly used complex aortic operation.


It is a two stage procedure:


Stage one - the elephant trunk graft, made from Dacron (synthetic material used to replace or repair blood vessels) is shaped in a tubular form. It is placed 


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Why do you need this surgery?


There are two main conditions that may occur to render Aortic Surgery


1) Aortic aneurysm is the localized dilation of a blood vessel and it may occur in any segment of the aorta


2) Aortic Dissection is a tear in the wall of the aorta. This causes blood to flow between the layers of the wall, or if the dissection tears through the aorta, there will be rapid and massive blood loss.


Your doctor would determine whether you would require this surgery. Most likely, the decision would be based on whether you have the symptoms of chest pain, shortness of breath, lightheadedness or fainting. These symptoms would indicate that the valve narrowing is severe and prompt replacement of the valve would be needed to prevent permanent heart damage.


If you have not developed the symptoms yet, your doctor may not recommend the surgery until after the symptoms develop. 


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How should you prepare for the surgery?


  • Please let your doctor know beforehand what medications you are on as some of these medicines may have to be stopped before the surgery.
  • If you are a smoker, you should stop smoking.
  • Give your doctor a list of your medical history, especially if you have any allergies if any.
  • You will be informed if you would need to undergo other tests prior to surgery, some tests you will need are:
          • ECG (electrocardiogram)
          • Blood tests
          • Chest x-ray
          • Urine sample
  • Your doctor will see you to explain the details of the procedure to you and answer your questions should you have any.


What happens before the surgery?


  • You will be asked to sign a consent form
  • You will not be allowed to eat or drink anything after midnight the night before surgery.
  • On the morning of the surgery, you will be ask to remove all accessories, dentures, undergarments etc.
  • You will be asked to empty your bladder just before the preoperative medication is given.
  • Preop medication which will help you to relax will then be given to you.



What happens during the surgery?


  • You will be given anaesthesia after entering the operating theatre
  • An incision will be made down the middle of the chest
  • Your breastbone will be separated to allow the surgeon to examine your heart
  • Your heart will be connected to the heart-lung bypass machine. This machine supplies oxygen to your blood and pumps it back to the rest of your body.
  • Now, the aortic surgery begins
  • The aorta is gently opened to reveal your aortic valve
  • The replacement valve will be sewn in place after the old valve is removed
  • After the aorta has been closed with stitches, you will slowly be removed from the heart-lung bypass machine after your heart regains strength.



What are the potential risks or complications?


  • No procedures are free from risk
  • Aortic Surgery has been performed for many years with successful results and there have been limited complications.
  • Minor complications include nausea and vomiting, infections at puncture sites, minor bleeding or allergic skin reaction. These often can be easily treated by your doctors.
  • Some major complications that may occur are infection, bleeding, heart attack or stroke.
  • There is also a very small possibility of loss of life occurring due to the surgery.



What happens after the surgery?


  • You will go to the intensive care unit (ICU) where you will stay for several days or as long as you need for observation. An electrocardiogram (ECG) monitor will record the rhythm of your heart continuously
  • You will have physical therapy, which includes walking around the hospital and other strengthening activities. You will learn how to move your upper arms without hurting your breastbone.
  • You will learn how to live a healthy lifestyle, such as choosing foods that are low in fat, cholesterol and salt, exercising regularly and not smoking



Going home


  • Have a relative or friend to pick you up on the day of your discharge
  • You will not need nursing at home, but it will be good to have someone help you with your shopping and also to support you for the first 10 days or so
  • Follow up with the pre-arranged check up at the hospital with your doctor


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