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Thoraco Abdominal Aorta

Frequently Asked Questions

Q. I've been told by my doctor that I need heart surgery. How can I be seen by the heart surgeons at Westchester Medical Center?

A. Most importantly, if you are experiencing chest pain, shortness of breath, or other acute symptoms, call 911 immediately. If you are not having acute symptoms, the first step is to call our office, at 866.962.4327. You can speak with our staff to schedule a consultation, or even get more information from one of our nurse practitioners.

Q. What types of surgery are performed by the heart surgeons of the New York Cardiothoracic Group?

A. The heart surgeons at NYCTG perform all types of cardiac and thoracic surgery. Cardiac operations performed include:

  • Coronary artery bypass grafting (CABG)
  • Mitral valve repair
  • Valve procedures, including:
    • Mitral valve replacement
    • Aortic valve replacement
    • Aortic valve repair
    • Tricuspid valve procedures
    • Minimally invasive valve surgery
    • Reoperative cardiac surgery
    • Repair of thoracic aortic aneurysms
    • Surgery for atrial fibrillation
    • Ventricular remodeling and heart failure surgery
    • Heart transplantation
    • Ventricular assist devices

Thoracic surgical conditions treated include:

  • Lung cancer sophageal cancer
  • Mediastinal tumors
  • Diseases of the airways

In addition, many thoracic conditions can be treated with VATS (video-asisted thoracoscopic surgery), which allows for less pain, faster recovery, and earlier discharge from the hospital.

Q. Where and when can I speak with a physician about my condition?

A. The surgeons' offices are conveniently located at the Westchester Medical Center in the Macy Pavilion. Visit the Contact Us / Directions tab for detailed directions. New patients can be seen by appointment, Monday through Friday.

Aortic aneurysms may result from a variety of predisposing conditions.

Degenerative dilation of the aortic wall is the most common cause of aneurysm formation. While the causes are not well understood, in some patients the elastic aortic tissue weakens prematurely, leading to progressive aneurysmal change. This process is sometimes referred to as cystic medial degeneration.

Atherosclerotic disease may produce calcification in the wall of the aorta, and other blood vessels, which damages cells in the media, leading to subsequent dilatation. Poorly controlled hypertension, as it subjects the aortic walls to higher pressure, may also contribute to aneurysm growth. Atherosclerosis has been found to be related to such factors as elevated cholesterol levels, cigarette smoking, diabetes, poor physical conditioning, and genetic predispositions.

Genetic diseases, such as Marfan's Syndrome or Ehlers-Danlos Syndrome, may lead to progressive dilatation of all segments of the aorta due to abnormalities in collagen, one of the proteins that are vital to the integrity of the aortic wall.

Aortic dissections may result in chronic dilatation of the aorta over time. An aortic dissection is caused by a tear in the inner lining of the aorta which allows blood to track within the wall of the aorta. Dissections of the ascending aorta must be repaired immediately, but dissections of the descending aorta may heal with careful blood pressure control. However, since the wall of the aorta is weakened, it may progressively dilate over time.

Inflammatory conditions, such as Takayasu's arteritis, may produce aneurysmal changes of the aorta as one of their manifestations.

Trauma, for example from motor vehicle accidents, may damage the wall of the aorta, leading to late aneurysm formation.

Bicuspid aortic valves may produce chronic dilatation of the ascending aorta, and may require replacement of both the aortic valve as well as the ascending aorta.

The decision to replace the ascending aorta is based on a number of criteria, namely symptoms, size, growth rate, and family history.

Symptoms

In the setting of an ascending aortic aneurysm, chest pain is a concerning symptom and may prompt definitive repair urgently. If you have an aneurysm and are experiencing chest pain, you should contact your physician or the nearest emergency room immediately.

Size

While there is no absolute size cutoff, most surgeons will begin to recommend repair of ascending aortic aneurysms when they reach approximately 5cm in size. For patients with Marfan’s Disease, surgery may be recommended for smaller sizes. Patients undergoing cardiac surgery for other reasons, primarily those with bicuspid aortic valves, may require concomitant aortic replacement at smaller sizes. Patients with ascending aortic aneurysms greater than 4cm should be followed with CT scans at regular intervals to evaluate growth of the aneurysm, as directed by their physician.

Growth Rate

The rate of change in size of an ascending aortic aneurysm may also influence the timing of surgery. Generally, the faster the aneurysm grows, the sooner it should be repaired.

Family History

Operation may be recommended sooner based on a patient’s individual family history. Those with history of genetic diseases, such as Marfan’s, Ehler’s-Danlos or other family history of aortic diseases may be candidates for surgical treatment earlier in their course.

CSF Drainage

We routinely place a catheter in the space around the spinal cord (an epidural catheter) which monitors the pressure of the cerebrospinal fluid (CSF) and allows us to drain fluid from the space if the pressure rises. This catheter is placed before the operation, and left in place for approximately 2-3 days, in order to provide safe perioperative spinal cord monitoring.

Distal Perfusion

During the operation, the patient is usually placed on a form of partial cardiopulmonary bypass support. This means of support allows the heart to continue to beat on its own, while maintaining blood flow and perfusion to the lower part of the body while the aortic replacement is taking place.

MEP / SSEP Monitoring

For all descending aortic operations in our practice, we use comprehensive neurologic monitoring equipment that measures both motor and somatosensory evoked potentials (MEP / SSEP). A non-invasive monitoring system is in place throughout the surgery and allows the surgeon to be aware of any changes in the neurologic function in real time. This facilitates changes in strategy during the surgery to lessen the risk of neurologic damage.

Hypothermia

All descending aortic surgery is performed with the use of moderate systemic hypothermia, which involves cooling the patient, lowering metabolic work and decreasing the risk of neurologic injury.

Open Repair

The traditional method of repairing thoracoabdominal aortic aneurysms involves a left thoracotomy, which is an opening between the ribs on the left side of the chest. The incision also involves opening a portion of the abdomen as well, so that the diaphragm can be reflected to expose the thoracic and abdominal aorta at the same time. The segment of the aorta containing the aneurysmal portion is removed and replaced with a Dacron graft. To accomplish this, we generally use a partial form of cardiopulmonary bypass, in which the heart continues to beat on its own.

Endovascular Stent Graft Repair

A newer type of aortic surgery has been introduced in the last few years which repairs aneurysms from within the aorta using endovascular stent grafts. With this technique, there is no need for “open” surgery or cardiopulmonary bypass – the repair is performed entirely within the aorta itself (hence the term endo-vascular repair).

By accessing the femoral artery in the groin, a graft is placed within the aortic aneurysm, effectively excluding that segment of aorta. While not every patient is a candidate for this technique, it offers shorter recovery time, less pain, and faster return to normal activities.

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