What is thoracic aortic aneurysm surgery?

Aortic aneurysm repair is surgery to fix a weak and bulging section of the aorta. The aorta is the large blood vessel (artery) that carries blood from the heart through the chest and belly to the rest of the body.

To repair the aneurysm, a doctor uses a man-made tube (called a graft) to replace the weak and bulging section of the aorta in your chest. The doctor will make a large cut in your chest. The doctor may connect you to a machine that does the jobs of your heart and lungs. It's called a heart-lung bypass machine. General anesthesia is used for this surgery.

You may spend several days in the hospital. You will need to take it easy for at least 4 to 6 weeks at home.

Activity

• Rest when you feel tired. Getting enough sleep will help you recover.
• Try to walk each day. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
• Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or aerobic exercise, for up to 3 months.
• For 6 weeks, avoid lifting anything that would make you strain. This may include a child, heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a vacuum cleaner.
• Hold a pillow over your incision when you cough or take deep breaths. This will support your chest and decrease your pain.
• Do breathing exercises at home as instructed by your doctor. This will help prevent pneumonia.
• Ask your doctor when you can drive again.
• You will probably need to take at least 4 to 6 weeks off from work. It depends on the type of work you do and how you feel.
• You may shower as usual. Pat the incision dry. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay.
• Ask your doctor when it is okay for you to have sex.

Diet

• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• You may not feel as hungry as usual, or food may not taste as good as it usually does. This is common and usually gets better about 4 weeks after surgery. If you do not feel like eating, you may want to drink liquid meal replacements for extra calories and protein. This can help you keep up your strength and prevent weight loss.
• Drink plenty of fluids (unless your doctor tells you not to).
• You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

Medicines

• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Be safe with medicines. Take pain medicines exactly as directed.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol. Too much acetaminophen (Tylenol) can be harmful.
• If you think your pain medicine is making you sick to your stomach:
  • Take your medicine after meals (unless your doctor has told you not to).
  • Ask your doctor for a different pain medicine.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

• If you have strips of tape on the incision, leave the tape on for a week or until it falls off.
• Wash the area daily with warm, soapy water, and pat it dry. Other cleaning products, such as hydrogen peroxide, can make the wound heal more slowly. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
• Keep the area clean and dry.

Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

Preparing for surgery

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what surgery is planned, along with the risks, benefits, and other options.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your surgery. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Aortic aneurysm repair is surgery to fix a weak and bulging section of the aorta. The aorta is the large blood vessel (artery) that carries blood from the heart through the chest and belly to the rest of the body. The doctor used a man-made tube (called a graft) to replace the weak section of your aorta in your chest.

You can expect the cut (incision) in your chest to be sore for a few weeks. If you have stitches or staples in your incision, the doctor will take these out 1 to 3 weeks after surgery.

You will feel more tired than usual for several weeks after surgery. You may be able to do many of your usual activities after 4 to 6 weeks. But you will probably need 2 to 3 months to fully recover.

Some people find that they feel sad or more emotional than usual while they are recovering after this surgery. This may last for up to 6 weeks after surgery. Talk with your doctor if your sadness continues or if you have concerns about how you are feeling. Treatment and other support can help you feel better.

Be sure to tell your dentist and doctors that you have the graft. This is important because you may need to take antibiotics before certain procedures to prevent an infection.

You will have regular tests, such as a CT scan, to check for problems with the graft. You may have at least one test each year.

The doctor will make a large cut (incision) in your chest. The cut may be made through the breastbone (sternum). Or it may be in the side of your chest between your ribs.

General anesthesia is used for this surgery. During the surgery, the doctor may connect you to a machine that does the jobs of your heart and lungs. It’s called a heart-lung bypass machine. This machine isn't always used.

The doctor will put clamps on the aorta above and below the aneurysm. This stops blood flow through the area that the doctor is working on. The doctor will replace the weak section of your aorta with a man-made tube (called a graft).

After the aorta is fixed, the doctor will remove the clamps. Blood can then flow through the aorta again. Then the doctor will use stitches or surgical staples to close the incision in your chest.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do not shave the surgical site yourself.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• The area for surgery is often marked to make sure there are no errors.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
• The surgery will take about 2 to 6 hours.
• You will probably go to the intensive care unit (ICU) after surgery. You will probably stay in the ICU for 1 or 2 days before you go to your regular hospital room.
• You will have a breathing tube down your throat. This is usually removed within 6 hours after surgery.
• You may have a thin plastic tube in your nose that goes down the back of your throat into your stomach to drain stomach juices. It is usually removed when the breathing tube is removed.
• You may have one or more tubes coming out of your chest to drain fluid that can build up after surgery. The chest tubes are usually removed within 2 days after surgery.