Thoracic Aortic Disease Treatment

Medical Therapy

Once diagnosis of a thoracic aortic aneurysm or dissection is confirmed and surgery is either currently unnecessary or is not an option, medical management and serial (routinely repeated) testing is required to minimize the growth and monitor the aneurysm or dissection, as well to evaluate each patient for coexisting diseases involving other organ systems. Serial testing is usually completed every 6 months to 1 year depending on each individual case. Patients with inheritable conditions, such as the Marfan Syndrome and the Loeys-Dietz syndrome, are at particular risk of death secondary to aortic dissection or rupture. Serial testing with timely surgical repair can prevent these catastrophic events.

• Echocardiogram
• Medication to control cholesterol
• Medications to minimize the growth rate of the aneurysm by slowing the heart rate, reducing the heart's force of contraction and lowering the blood pressure
• Restriction of physical activities, especially those requiring heavy lifting
• Risk Factor Modification

Surgery

Surgical repair is necessary when a thoracic aortic aneurysm or aortic dissection becomes life, limb or organ threatening. Surgery is carefully planned and executed in a manner that minimizes patient risk. The Thoracic Aortic Disease program at the Bluhm Cardiovascular Institute performs both standard open surgery and minimally invasive surgery (endovascular repair) to correct a thoracic aortic aneurysm or dissection.  

The Thoracic Aortic Disease program is co-directed by vascular surgeon, Mark K. Eskandari, MD, and cardiac surgeon, S. Chris Malaisrie, MD.

Open Surgery

Everyone is not a candidate for minimally-invasive endovascular repair, due to the small diameter of the femoral artery or the location of the thoracic aortic disease. For those patients where endovascular repair is not an option, “open” surgery is performed. The standard incision for open surgery is a full sternotomy which involves a 6- to 8-inch incision down the middle of the chest, allowing the surgeon direct access and a direct view of the diseased thoracic aorta. After surgery, the breastbone is wired together and the incision is closed with sutures.

Some descending aortic arch repairs using the open reconstruction technique may only require a left thoracotomy, which involves a small incision between the fourth and fifth rib space on the left side of the chest.

Aortic Root Replacement

Repair of an aortic root aneurysm or dissection is done by replacing the aortic valve if it is diseased and the portion of the aorta that is diseased with a tubular graft of synthetic (man-made) material.

David Procedure:  This aortic root replacement surgery repairs the diseased aortic root with a synthetic graft; the original aortic valve is left in place.

Modified Bentall Procedure: The traditional aortic root replacement surgery consists of replacing both the aortic valve and the aortic root with a composite (combined) valve-graft. Typically, the composite valve-graft consists of either a tissue valve or a mechanical valve (to replace the diseased aortic valve) attached to a tubular synthetic graft (to replace the diseased aortic root). If a mechanical valve is used, an anticoagulation medication like Warfarin will be necessary. If a tissue valve (made from animal or human tissue) is used, anticoagulation medication is not necessary.

Aortic Arch Replacement

Aneurysms or dissections may involve more than just the aortic root. The aortic arch and the descending aorta can also be diseased. Repair of the aortic arch and the descending aorta is made with a tubular synthetic graft.

Descending Aortic Arch Repair: Aneurysms or dissections may also occur in the descending aorta just beyond the left innominate artery, left common carotid artery and the left subclavian artery. The diseased portion of the aorta is removed and replaced with a synthetic graft.

Hemi-Arch Repair: A small portion of the aortic arch is removed and replaced with a synthetic graft. Native aortic arch tissue is left in place surrounding the left inominate artery, left common carotid artery and the left subclavian artery than in the total arch repair surgery.

Total Arch Repair: The entire aortic arch, except for the brachiocephalic patch (area where the left innominate artery, left common carotid artery and the left subclavian artery originate), is removed and replaced with a synthetic graft.

In some cases, more than one section of the aorta is diseased and must be repaired. For example, disease in the aortic root and a portion of the aortic arch may require an aortic root repair and a hemi-arch repair to be performed at the same time. In these cases, the different synthetic grafts are sewn together after each portion of the aorta is repaired.

Minimally Invasive Endovascular Therapy

Stent Graft Repair

Endovascular or transcatheter repair of the thoracic aorta is a minimally invasive surgical technique. A very small catheter (hollow, flexible tube) that contains a stent graft (usually a stainless steel mesh tube) is inserted into the femoral artery via a tiny skin incision. The catheter is then advanced into the diseased portion of the thoracic aorta where the graft is placed. The purpose of the graft is to direct blood flow through the graft and away from the aneurysm so that the aneurysm does not increase in size; the chance of bursting is decreased.

Because endovascular repair is usually performed through the groin via the femoral artery, it is important that the size of a patient’s femoral artery is large enough to accommodate a catheter. Women may have femoral arteries that are too small for this technique.

Because these catheter-based procedures are considered minimally invasive, patients experience the following benefits:

• Faster return to normal daily activities
• Improved clinical outcomes
• Less blood loss
• Less pain
• Shorter recovery time
• Smaller incisions with less scarring

The principal goals of the Thoracic Aortic Surgery program include:

• Achieving the best long-term clinical outcomes for each patient
• Practicing the safest techniques of circulation management using specialized perfusion techniques during surgery on the thoracic aortic
• Relying on a comprehensive system of monitoring heart, brain, and spinal cord function during the complex surgeries required to treat thoracic aortic diseases
• Utilizing the most advanced therapies available

Outcomes

At the Bluhm Cardiovascular Institute, we evaluate our clinical outcomes so that we can fully understand how our treatments and procedures benefit our patients. We regularly review and evaluate our clinical outcomes and, based on the results, develop methods to monitor and improve the healthcare we offer to our vascular patients. (LINK)

Patient Stories

Individuals from across the country travel to the Bluhm Cardiovascular Institute to receive exceptional patient care and the most advanced treatments available. Meet our patients who were successfully treated for thoracic aortic disease.

Clinical Trials

Ongoing clinical research trials at the Center for Vascular Disease are investigating new treatment options for thoracic aortic disease to ensure that our patients receive the most innovative care in the country. For more information regarding these clinical trials, visit the Clinical Trials Unit of Northwestern, send an e-mail or call 312-926-4000.

Contact Us Today

For more information regarding thoracic aortic disease and the treatments available, please contact the Bluhm Cardiovascular Institute at 866-662-8467. To schedule an appointment, please call 312-695-4965 or request a first-time appointment online.