Aortic surgery – Herz- und Gefäßchirugie

The aorta

The aorta connects directly to the heart and transports the blood that is pumped from the heart through the body. Under normal circumstances, the largest vessel in the human body is about 3 cm in diameter. However, due to various causes, a pathological enlargement of the aorta can occur, and this is called an aneurysm. Since the increasing diameter of the aneurysm is accompanied by thinning of the vessel wall, the dilated portion must be replaced with a vascular prosthesis to prevent rupture and allow the patient to live a normal life.

The indication for surgery

The indication for aortic surgery is usually 5.5 cm, but can also be as low as 4.5 cm, depending on concomitant diseases and the patient’s individual risk profile. The diagnosis and indication for surgery is made with the help of modern examination techniques such as computer tomography (CTComputed tomography.) or magnetic resonance imagingMagnetic resonance imaging, MRI. Diagnostic procedure without the use of X-rays. Magnetic fields are used to produce images of organs and body structures. (MRIMagnetic resonance imaging – diagnostic procedure without the use of X-rays. Magnetic fields are used to produce images of organs and body structures.) and the planning of the operation is also carried out with the help of the sectional images.

Depending on the location of the aneurysmAbnormal dilatation of a blood vessel or a chamber of the heart., the specialists have various surgical procedures at their disposal, which will be discussed with you in detail beforehand. If the aortic root is also affected, we will clarify in advance whether the patient’s own heart valveIn the inflow and outflow area of the heart chambers there are valves which prevent the blood from flowing back in the wrong direction. Each heart half has a sail valve and a pocket valve: 1. Tricuspid valve (between the right atrium and right ventricle) 2. Pulmonary valve (between the right ventricle and pulmonary artery) 3. Mitral valve (between the left atrium and left ventricle) 4. Aortic valve (between the left ventricle and the aorta). can be preserved (David procedure), or whether the valveValve. must be additionally replaced with a mechanical or biological valve prosthesisReplacement part for a missing or no longer functioning organ or body part, e.g. heart valve prosthesis. (Bentall procedure).

If the aortic archTopmost, arch-shaped part of the aorta. Here the vessels branch off towards the head and arms., i.e. the section from which the head and neck vessels leave, is also affected, special techniques must be used to protect the brain and spinal cord. These techniques allow the dilated portions to be removed and replaced with vascularConcerning the blood vessels. prostheses safely and with little risk to the patient. All these procedures must be performed with a heart-lung machineEquipment that takes over the work of the lungs and the stopped heart during heart surgery. The blood is directed from the vena cavae and thus out of the body into the machine, where it is enriched with oxygen and then pumped back into the body. During this process, the blood is cooled down and warmed up again after the operation., opening the chest.

If the descending part of the aortaThe main major artery in the body. Leads from the left ventricle via an arch in the thoracic cavity to the abdominal cavity. There it splits into two large iliac arteries. is affected, we have interventional treatment procedures available in this case, in which a vascular support, a stentSpiral-shaped, lattice-like vessel supports, usually made of a precious metal. Used when balloon dilatation has not produced the desired results or to close off aneurysms of the great vessels., is inserted into the diseased section via a groin access, thus eliminating the diseased section without opening the chest.

Aortic dissection

A dissection means that a tear occurs in the innermost layer of a vessel and blood burrows through the layers of the vessel. In the worst case, this leads to a rupture of the vessel or to consequential damage caused, for example, by reduced blood flow. Aortic dissection is a condition that is associated with a high mortality rate if left untreated.

On the one hand, aortic dissections are differentiated according to the location of the tear and the time course.

If the tear is in the area of the ascending aorta or the aortic arch, it is called a Stanford type A dissection. If the tear is behind the left subclavian arteryA blood vessel leading away from the heart that transports oxygenated blood to the organs. Arteries pulsate and can be palpated on the wrist, for example (pulse). The aorta is the main artery of the body., the dissection is classified as Stanford type B.

An aortic dissection is usually accompanied by a severe pain event, but the symptoms of a dissection can also be very variable and can be manifested, for example, by neurological disorders, sudden heart failure or a heart attack.

If the onset of symptoms was less than 14 days ago, the dissection is classified as acute. If the onset of symptoms is more than 14 days ago, it is called a chronic dissection.

The indication for surgical treatment results from the localisation of the dissection and the temporal classification. An acute type A dissection is an absolute emergency indication for which patients must be treated surgically immediately. A chronic type A dissection should also be treated surgically, but the procedure can be performed under planned conditions.

In both acute and chronic type B aortic dissection, the first priority is conservative treatment with medicationAdministration and dosage of a medicine. and close monitoring. In the further course, treatment can then be carried out using a vascular stent, which covers the tear and reinforces the vessel inside.

In the Department of Cardiovascular Surgery, specialists are available around the clock to ensure the surgical care of patients with a dissection.