Open Thoracoabdominal Repair for Thoracoabdominal Aortic Aneurysm

An aneurysm is an area of an artery that becomes dilated, or balloons outward, weakening the vessel wall.

There are multiple types of aneurysms including thoracic and thoracoabdominal aortic aneurysms (TAA and TAAA) and abdominal aortic aneurysm.

Contact the UPMC Heart and Vascular Institute

To request an appointment, contact the UPMC Heart and Vascular Institute:

• Call: 1-855-876-2484
• Email: HeartandVascular@upmc.edu

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To refer a patient to the Center for Thoracic Aortic Disease, call 412-647-7070 or email AorticCenter@upmc.edu.

For emergencies and immediate referrals, call 412-647-7070 or fax 412-623-3717.

What Is Open Thoracoabdominal Aneurysm Repair?

Open thoracoabdominal repair is the conventional surgical approach in the treatment of thoracoabdominal aortic aneurysms (TAAAs).

The goal of this procedure is to replace the diseased section of aorta to prevent aortic rupture or dissection. Both can be fatal events.

During this operation, surgeons replace the dilated part of the aorta with a tube-shaped Gortex graft. At the same time, they maintain blood flow to the spinal cord and other vital organs supplied by the aorta.

Is Open Thoracoabdominal Repair Surgery Right for Me?

TAAA is a serious diagnosis which requires:

• Careful, lifelong surveillance with an aortic expert.
• Strict blood pressure control.
• Healthy lifestyle changes.

However, not everyone who has a TAAA will need surgery within their lifetime.

The experts at UPMC's Center for Thoracic Aortic Disease can provide you precise guidance on how to best treat your TAAA.

When possible, your surgeon may choose to simply monitor the aneurysm with serial CT scans and control your blood pressure with medications.

Your surgeon may recommend surgery based on:

• The diameter of the aorta — that is, how much it has stretched beyond normal size.
• If you have underlying connective tissue disease - Marfan's Syndrome, Loeys-Dietz Syndrome, or Ehlers-Danlos Syndrome.
• How fast the aorta is growing,
• How well your aortic valve is working.

Open Thoracoabdominal Repair Surgery: Risks and Complications

The procedure does carry some serious risks, including paralysis or partial paralysis of the lower body and legs. But this is rare.

Surgeons take many steps — such as draining spinal fluid — during surgery to prevent damage to the spinal cord.

All major surgery carries a risk of bleeding and infection.

Your doctor will review all the risks of open TAAA repair surgery.

How To Prepare for Open Thoracoabdominal Repair

Before surgery, you'll meet with your surgeon to review your medical history and health or social factors relevant to treatment.

Your surgeon will also describe the procedure and its risks and benefits, giving you time to ask questions.

You will also have pre-op tests, such as lab work and imaging scans.

What To Expect Before, During, and After TAAA Repair Surgery

Before surgery

You may have one support person with you when you arrive for surgery. You'll need to have this person approved in advance. Be sure to check the latest COVID guidance for visitors before coming to the hospital.

If you have a CPAP machine, please bring it with you.

When you get to the hospital, you will:

• Meet with your care team for final preparations.
• Receive an IV and general anesthesia so you'll sleep through the procedure.
• Have a lumbar drain placed into your spinal column, which drains fluid around the spinal cord during surgery. You may need this drain for 1 to 3 days after surgery to protect your spine.
• Meet with your care team for final preparations.
• Have an IV placed.
• Have a lumbar drain placed into your spinal column, which drains fluid around the spinal cord during surgery to protect your spine. You may need this drain for 1 to 3 days after surgery to protect your spine. 
• Receive general anesthesia so you'll sleep through the procedure. 

During surgery

During open TAAA repair surgery, your surgeon and care team will:

• Place you on a heart-lung machine to do the work of your heart and lungs. This allows your surgeon stop blood flow to the surgical site so they can work in a still, bloodless field.
• Make an incision between your ribs on the left side of the chest. The length of the cut depends on how much of the aorta needs repaired.
• Remove the diseased part of the aorta and replace it with a tube-shaped woven fabric graft.
• May also need to repair blood vessels that branch off of the aorta. They may use a piece of vein from your leg to do this.

Once the repair is complete, your surgeon will close the incision with stitches under the skin.

After open thoracoabdominal repair surgery

Here's what to expect during your post-op recovery:

• You'll stay in the cardiothoracic ICU for about 3 to 4 days before moving to a regular room.
• Once you wake from anesthesia and move off a ventilator, your care team will let you slowly start eating. They'll first give you ice chips and then work your way up to real food. Most patients are not able to eat regular food for a few days for multiple reasons related to the surgery. You care team will advance your diet slowly and as appropriate for your clinical condition.
• You will have between 1 and 3 drains in your body to prevent fluid build-up. You'll need to lay flat on your back in bed while the lumbar drain is in, about 1 to 3 days.
• You will have post-op pain. Your care team will give you medicine to help you manage it.
• You'll also use a device to learn breathing exercises to keep your lungs clear and prevent pneumonia.
• Once out of the ICU, you'll start rehab to help you get stronger before going home. It's vital to get up and moving as much as you can.
• Before discharge, your care team will go over how to care for yourself at home. Feel free to ask any questions before you leave the hospital. Once home, call your care team if you have questions or concerns.
• You must have someone stay with you around the clock for the first 7 days after you go home. If you don't have someone to stay with you, we can help you find a skilled nursing or rehab center.

How Long Does It Take to Recover After Open TAAA Repair?

After leaving the hospital, it'll take a few weeks to start feeling like yourself again.

You will need to take it easy and avoid driving and lifting anything heavier than 10 pounds until your follow up appointment.

Other ways to aid recovery are to:

• Take brief walks throughout the day. This helps strengthen your body and keep your blood flowing.
• Elevate your legs above your heart when sitting to help prevent swelling of the feet and legs.
• Use your device and do breathing exercises at least 10 times per hour to strengthen your lungs and prevent pneumonia.

Recovery times vary for each person.

As you start to heal, you may have:

• Pain.
• Shortness of breath.
• Fatigue.
• Swelling of the arms, hands, feet, or legs.
• Trouble sleeping.

Your doctor will prescribe home nursing care a few times a week. A nurse will check your vital signs and incision, and let your doctor know how you're healing.

You will see your surgeon for follow-up about 4 weeks after surgery.

At that time, your surgeon will clear you to return to most of your usual activities. You'll also receive a script to start local outpatient cardiac rehab.