An ascending aortic aneurysm is a dilation of the aorta, your body’s largest blood vessel. It develops in the part of the blood vessel close to your heart called the ascending aorta. When the dilation is severe enough that it changes the shape of the aorta, it is called an aneurysm.
Ascending aortic aneurysm repair is an open-heart surgery that replaces the abnormal, weakened part of the aorta with a synthetic graft. By replacing the diseased part of the aorta, your body is protected from complications such as an aneurysm rupture. Sometimes the aneurysm can extend into nearby areas, such as the aortic root or the aortic arch. If that happens, those sections may also need to be replaced or repaired.
At Mass General Brigham Heart and Vascular, our surgeons specialize in many complex aneurysm treatments, including ascending aortic aneurysm repair. During the procedure, the surgeon removes the abnormal part of the aorta and replaces it with a tube made from synthetic material. The tube, called a graft, restores the normal structure of your ascending aorta and helps prevent further dilation and rupture of the aneurysm.
There are different scenarios where the aortic aneurysm needs to be fixed to prevent life-threatening complications like rupture or dissection:
Over time, aneurysms can break open (rupture) or cause a tear (dissection) in the blood vessel wall. These problems can be life-threatening, so we may recommend surgery to prevent them.
A rupture or dissection can present in different ways. Commonly, it causes sudden, severe chest or back pain. People often describe the pain as a stabbing or ripping sensation. In other cases, people report lightheadedness, weakness, sweating, and nausea or abdominal pain. If you experience any of these symptoms or other signs of an emergency, seek immediate medical attention.
If a rupture or dissection occurs, our world-class heart team is equipped to perform emergency, often lifesaving surgery. We perform more than 3,000 heart procedures each year. This experience allows us to provide you and your loved ones with the best possible care.
The size threshold for surgery is personalized based on your condition. Guidelines from the American College of Cardiology and the American Heart Association help our doctors determine when an aortic aneurysm should be repaired. Your care team will consider these and other criteria to develop a personalized treatment plan that’s right for you.
At Mass General Brigham, patients with aortic aneurysms are closely followed over time. Our team of cardiothoracic surgeons and aortic cardiologists work together using a shared decision-making approach to determine the best timing and type of treatment for each individual.
People with a dilated aorta are typically followed with regular imaging. If the aorta reaches about 5 centimeters (cm) or greater, a surgical consultation is often recommended. In some cases, aneurysm repair may be advised at a smaller size.
We also factor in your medical history and the risks of open-heart surgery. You may need surgery sooner if you have other heart conditions, such as bicuspid aortic valve or genetic diseases like Marfan syndrome. Our goal is to repair the aneurysm before it poses a greater risk than surgery itself.
Surgery for an ascending aortic aneurysm is a proactive step to protect your long-term health and avoid an emergency, including an aneurysm rupture or aortic dissection. If these medical emergencies do happen, surgery can save your life.
Open-heart surgery to fix ascending aortic aneurysms has excellent success rates if performed as a planned (elective) procedure rather than in an emergency.
You will need several tests to assess your heart, blood vessels, and overall health before getting aortic aneurysm surgery. These tests help us identify potential risks and prepare for a safe procedure.
Our specialists use advanced imaging techniques to diagnose and monitor aortic conditions, including, including:
For elective procedures, you and your surgeon will discuss how you should prepare for surgery. You may need to stop or change certain medications before surgery. You will need to stop eating or drinking at a certain time before your surgery.
A nurse will call you the day before your procedure to provide specific instructions about arriving at the hospital and what to expect.
You’ll stay in the hospital for several days after surgery, so plan to bring any essentials with you. You will also need to arrange for someone to take you home when you’re discharged.
During aortic aneurysm repair, you receive general anesthesia to make you fall asleep. Our expert anesthesiologists make sure that you don’t have awareness or feel anything during surgery.
The procedure usually takes about three to four hours and involves:
If you have other aortic problems, we may address them during the same procedure. Your surgeon will discuss this with you beforehand. Additional repairs may include:
After aortic aneurysm repair, you will wake up in our cardiac surgical ICU (CSICU). We monitor you closely as you regain consciousness. Once stable, you’ll move from the CSICU to our step-down unit, where you can expect to stay for a few days. In the step-down unit, the focus shifts to physical therapy and getting you back to your independent lifestyle.
You receive personalized, attentive care in both the CSICU and the step-down unit from specially trained nurses and providers. Open-heart surgery is a major surgery, and your body needs support to recover. You may temporarily need:
Before you leave the hospital, your surgeon will discuss your personalized recovery plan, including:
Full recovery from ascending aortic aneurysm repair takes several months. But most patients regain strength and resume normal activities in about one month with proper care and rehabilitation.
Ascending aortic aneurysm repair is achieved using traditional open-heart surgery. This means we open the chest wall with a cut (incision) in the middle of your chest to gain access to the aorta.
During surgery, we temporarily stop blood flow through your aorta. Then, we remove the aneurysm. In its place, we sew a synthetic tube that restores the blood vessel’s normal structure.
In emergency situations, your heart surgeon may recommend a minimally invasive approach called thoracic endovascular aortic repair (TEVAR). TEVAR may be considered for high-risk patients who cannot undergo open-heart surgery.
While TEVAR is typically used for descending aortic aneurysms, it is sometimes offered as an alternative for select patients.
Ascending aortic aneurysm repairs have excellent success rates. Most people have great long-term outcomes with surgery.
You will stay in the hospital for about 4 to 7 days after surgery. Before you go home, your care team will make sure you’re able to safely resume daily activities. You’ll be encouraged to resume your normal daily activities, with the exception of lifting heavy objects with your arms, which should be avoided to allow your bone to heal properly.
While every recovery is different, most people begin to feel their energy and strength returning within 4 to 6 weeks. However, it may take a few months to fully recover from open-heart surgery.
The ascending aorta is just one portion of the entire aorta. In some people, aortic aneurysms can develop in other areas that were not replaced during surgery. That’s why we continue to monitor you closely after your procedure, using regular imaging and follow-up care to catch any new changes early.
Yes, many patients can safely become pregnant after an aortic aneurysm repair. However, some individuals may still have dilated areas in other parts of the aorta that require close monitoring during pregnancy. If you are considering pregnancy, talk with your provider about your health history to understand your risk.
