What Is Open Thoracoabdominal Aortic Aneurysm Repair?
Open thoracoabdominal aneurysm repair is the conventional surgical approach in the treatment of thoracoabdominal aortic aneurysms (TAAAs).
This procedure aims 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.
Why Would I Need Open TAAA Repair?
TAAA is a serious diagnosis that requires:
- Careful, lifelong surveillance with an aortic expert.
- Healthy lifestyle changes.
- Strict blood pressure control.
However, not everyone who has a TAAA will need surgery within their lifetime. The experts at UPMC can provide you with precise guidance on how to best treat your TAAA.
When possible, your surgeon may choose to monitor your aneurysm with routine CT scans and control your blood pressure with medications.
Who’s a candidate for open TAAA repair?
You may be a candidate for open TAAA repair based on:
- How fast your aorta is growing.
- How well your aortic valve is working.
- If you have underlying connective tissue disease, such as Marfan syndrome, Loeys-Dietz syndrome, or Ehlers-Danlos syndrome.
- The diameter of the aorta — that is, how much it has stretched beyond its normal size.
What Are the Risks and Complications of Open TAAA Repair?
Although rare, open TAAA repair can carry serious risks, including paralysis or partial paralysis of the lower body and legs.
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 with you before your procedure.
What Should I Expect from Open TAAA 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. You will also have pre-op tests, such as lab work, an exercise stress test, lung function tests, and imaging scans. Imaging tests may include:
- Magnetic resonance imaging (MRI) scan — Uses a magnetic field and radio waves to create images of your heart.
- Computerized tomography (CT) scan — Creates images of your heart.
- Echocardiogram — Uses sound waves to create images of your heart and blood vessels.
Before: How to prepare for open TAAA repair
Your doctor will explain the open TAAA repair procedure to you and give you a chance to ask questions. To prepare for the procedure, you should:
- Tell your doctor if you are sensitive or allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).
- Tell your doctor about all medications (prescription and over-the-counter) and herbal or other supplements you are taking.
- Tell your doctor if you have heart valve disease, as you may need to receive an antibiotic before the procedure.
- Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medications, aspirin, or other medications that affect blood clotting. It may be necessary to stop some of the medications prior to the procedure.
- Fast for a certain period of time prior to the procedure. Your doctor will tell you how long to fast (usually overnight).
- Have any tests that your doctor recommends. For example, your doctor may request a blood test prior to the procedure to determine how long it takes your blood to clot.
On the day of your procedure, be sure to bring your photo ID and health insurance card(s). Leave valuables such as cash and jewelry at home. If you have a CPAP machine, please bring it with you.
You will need to stay in the hospital for several days after your procedure. You should bring toiletries, a robe, slippers, a cell phone and charger, medications, and a change of clothes. You should also arrange for someone to drive you home from the hospital after you are discharged.
How long does open TAAA repair take?
Open TAAA repair may take several hours, depending on your condition and the complexity of your repair.
During your open TAAA repair
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 to drain fluid around the spinal cord during surgery. You may need this drain for 1 to 3 days after surgery to protect your spine.
- Have an IV placed.
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 your aorta needs to be repaired.
- Remove the diseased part of your aorta and replace it with a tube-shaped woven fabric graft.
- May also need to repair blood vessels that branch off of your aorta. They may use a piece of vein from your leg to do this.
After the repair is complete, your surgeon will close the incision with stitches under the skin.
Recovery after open TAAA repair
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.
- After you wake up from your 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. Your care team will advance your diet slowly and as appropriate for your clinical condition.
- You will have between 1 to 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 for 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.
- After you are 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. After you get home, call your care team if you have questions or concerns.
- You must have someone stay with you around the clock for the first seven 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 normal 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 your recovery include:
- Taking brief walks throughout the day. This helps strengthen your body and keep your blood flowing.
- Elevating your legs above your heart when sitting to help prevent swelling of the feet and legs.
- Using your breathing device to 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:
- Fatigue.
- Pain.
- Shortness of breath.
- 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 four weeks after surgery. At that time, your surgeon will clear you to return to most of your usual activities. You'll also receive a prescription to start local outpatient cardiac rehabilitation.
When to call your doctor about open TAAA repair complications
You should let your doctor know if you have:
- A fever of more than 100.0°F.
- Difficulty breathing.
- Difficulty swallowing, throat pain, or bloody cough.
- New or increasing shortness of breath.
- Pain, redness, bleeding, drainage, or increased swelling at the insertion site.
- Rapid or pounding heartbeat.
What are the outcomes of open TAAA repair?
Most people are able to live full and active lives after open TAAA repair. However, your doctor may recommend that you avoid strenuous activities.
What’s the success rate of open TAAA repair?
Open TAAA repair is a life-saving procedure that can improve your lifespan and quality of life. Although the procedure is complex and poses certain risks, many people have outstanding outcomes and are able to get back to their normal activities.
Why Choose UPMC for Open TAAA Repair?
UPMC vascular surgeons perform emergency and elective surgery to treat all types of aortic disorders. Our skilled team also offers ongoing monitoring for people with TAAAs and provides expert guidance on the management of complex TAAAs.
By UPMC Editorial Staff. Last reviewed on 2024-10-01.
