Center for Aortic Surgery at Heart Hospital NM

While damage to the aorta can be caused by an injury; often the damage is caused by certain diseases and health conditions. Some of these health risk factors include:

• Age
• Tobacco use
• High blood pressure
• Coronary artery disease
• Hardening of arteries/buildup of plaque in arteries
• Marfan Syndrome
• Family history
• Untreated infection

Patients who have a connective tissue disorder(s) require a multi-disciplinary approach to their care, long-term and short term. The connective tissue provides support to many structures within the body, including the heart valves and the aorta (blood vessels.) If you or your patient have a connective tissue disorder, consider including one of our cardiothoracic providers to be a part of his or her care team.

According to the Center for Disease Control and Prevention (CDC), it is estimated that more than 43,000 individuals die each year from aortic diseases. This means if you or your patient have an aortic disease, it is vitally important that the individual be treated by an experienced and highly-skilled team of cardiovascular surgeons and specialists.

If left untreated, many common health risk factors may lead to the following aortic conditions:

• Aortic aneurysm
• Aortic dissection
• Aortic infection
• Aortic intramural hematoma
• Aortic valve disease
• Aortic valve regurgitation
• Aortic valve stenosis
• Aortobronchial fistula (ABF)
• Aortoenteric fistula (AEF)
• Bicsupid aortic disease
• Coarctation of the aorta (CoA)
• Mitral valve disease
• Mitral valve regurgitation
• Mitral valve stenosis
• Thoracic aortic disease
• Tricuspid valve disease
• Tricuspid valve regurgitation

Surgery is typically needed when there is an aortic aneurysm that can lead to aortic dissection. Aortic aneurysm is when a part of the aorta, either in the chest of abdomen area, forms an abnormal balloon-like bulge. The aneurysms can be tube-shaped (fusiform) or have a round shape (saccular. Aortic aneurysms form when an area of the aortic wall becomes weakened. As blood is pushing against the vessel wall, it can cause the bulge to form. Often times, aortic aneurysms can grow slow and without symptoms, making them difficult to detect. It is possible to live with an aneurysm, as some may never rupture. Many start out small and stay small, but tend to expand over time as the vessel wall continues to weaken. It is difficult to predict how quickly an aneurysm may grow.

An aortic aneurysm can develop anywhere on the aorta.

• An aortic aneurysm that occurs in the abdomen is called an abdominal aortic aneurysm.
• An aortic aneurysm that occurs in the chest is called a thoracic aortic aneurysms. This type of aneurysm can be formed in the aortic root, ascending aorta, aortic arch or the descending aorta.
• An aortic aneurysm that involves the aorta as it flows through both the abdomen and chest are called thoracoadcominal aortic aneurysms.

The cause, size and growth of the aortic aneurysm may cause the course of treatment to vary from watching a patient's condition carefully to emergency surgery. Ideally the surgery would be planned, if necessary. Essentially, the larger the aneurysm, the greater the risk for a rupture, or aortic dissection.

Aortic dissection is when one of the inner layers of the aorta is torn apart through increased blood pressure, causing the aorta to bleed within itself. When an aortic dissection occurs it feels like a severe, sharp, tearing pain in the chest and back, as the aorta is being torn. Other symptoms may include:

• Shortness of breath
• Rapid, weak pulse
• Fainting or dizziness
• Symptoms of a stroke

Aortic dissections are very serious, life-threatening conditions.

Open-heart or open-chest surgery to repair an aneurysm by removing the damaged sections. Once the damaged section is removed, the surgeon places a synthetic reinforced graft (tube) in its place.

Either open-chest or a minimally invasive surgery, depending on the case. The surgeon replaced the damaged valve with a mechanical or biological valve (usually made from cow, pig or human heart tissue.)

This procedure is for patients who are not candidates for valve replacement surgery. This is a catheter-based procedure that is used as a palliative treatment to help improve the symptoms of aortic stenosis.

A combination of open-chest surgery with endovascular, or catheter-based surgery to treat aneurysms of a complex nature. Typically, this surgical option is used when one procedure is not enough to treat or repair the aorta wall.

An innovative, nonsurgical, minimally invasive valve replacement procedure. Beginning with a small incision in the thigh, the surgeon inserts a catheter through a leg artery and threads in a synthetic reinforced graft (tube) into the aorta. This procedure is ideal for patients who have a thoracic aortic aneurysm, at risk of aortic dissection, or cannot tolerate a traditional aorta surgery. This procedure typically provides less pain, shorter recovery time and few complications with lower chances of infection.

This specialized operation is used to repair the part of the aorta that connects to the heart by sparing the patient's own heart valve. This is typically used when there is an aortic ulcer that occurs right where the aorta meets the heart.

Aortic valve repair surgery may be done by traditional open-heart surgery, or by using minimally invasive techniques. Depending on the severity of the patients’ condition, the patient may be a candidate for a valve repair rather than a replacement. Generally speaking, a valve repair is usually the first choice (versus a replacement) since it is associated with lower infection rate, reduces the need for life-long blood thinning medication, and may help preserve the valve strength and function.

A Transcatheter aortic valve replacement (TAVR) is a minimally invasive heart procedure that is performed by inserting a new valve within the old, diseased valve. This procedure is used to replace a thickened aortic valve that is unable to fully open due to calcification (aortic stenosis) and help restore proper blood flow. The results of a TAVR procedure are reduced symptoms of aortic stenosis (such as chest pain, shortness of breath, fainting and fatigue.) TAVRs are routine procedures and are now considered in all patients with aortic stenosis needing aortic valve replacement.

The TAVR procedure is performed in a number of ways, but most commonly it is done using the Transfemoral approach (entering the femoral artery through a small incision in the groin.)