Open Aortic Surgery

What Is Open aortic surgery?

Open aortic surgery, is a surgical procedure used to repair or replace a diseased section of the aorta. Open surgery involves making a incision to directly access the aorta, allowing surgeons to remove damaged tissue and reconstruct the artery or implant a graft.

How Does It Work?

During open aortic surgery, the patient is placed under general anesthesia. The surgeon makes an incision in the chest, abdomen, or both, depending on the location of the affected aorta. Cardiopulmonary bypass is used to maintain blood flow to vital organs. The aorta is temporarily clamped to stop blood flow to the damaged section, which is then repaired or replaced. After the repair is completed, the incision is closed, and the patient is moved to a recovery area.

When Is Open Treatment Used?

Open aortic surgery is typically recommended in the following situations:

  • Large or rapidly expanding aortic aneurysms.

  • Aortic dissections.

  • Infections or trauma affecting the aorta.

  • When endovascular procedures are not feasible or have failed.

The decision to proceed with open surgery depends on the patient’s overall health, the location and size of the aortic problem, and the risks versus benefits of alternative treatments.

Benefits and Limitations

Benefits:

  • Provides a definitive repair of complex aortic conditions.

  • Allows direct visualization and precise repair of the affected aorta.

  • Often has long-term durability.

Limitations:

  • Requires a longer recovery period than endovascular procedures.

  • May not be suitable for patients with severe comorbidities or poor overall health.

  • Involves larger incisions and more extensive postoperative care.

What to Expect During the Procedure

Patients can expect a thorough preoperative evaluation, including imaging studies, blood tests, and consultations with the surgical and anesthesiology teams. On the day of surgery:

  • General anesthesia is administered.

  • The surgeon performs the incision and repairs or replaces the damaged aorta.

  • The procedure can last several hours, depending on the complexity.

  • In cases where the ascending aorta, aortic arch or the descending aorta are replaced, the surgery will most likely be performed using cardio-pulmonary bypass.

After surgery, patients are monitored in an intensive care unit (ICU) before moving to a regular hospital room for further recovery.

Possible Risks and Complications

As with any major surgery, open aortic surgery carries potential risks, including:

  • Bleeding or blood clot formation.

  • Infection at the incision or within the body.

  • Heart attack, stroke, or organ dysfunction.

  • Graft-related complications such as leakage or narrowing.

  • Prolonged recovery or the need for additional procedures.

Surgeons carefully evaluate each patient’s risk profile and take steps to minimize complications. Close follow-up after surgery is essential to ensure optimal outcomes and detect any issues early.

Recovery and Follow-Up

Hospital stay: Typically 1–2 weeks, with intensive monitoring in the early postoperative period

Rehabilitation: Gradual return to normal activity over weeks to months, supported by cardiac rehabilitation programs

Imaging: Lifelong surveillance with echocardiography, CT, or MRI to monitor the graft, valve function, and remaining aorta

Medication: Blood pressure–lowering medications are essential; anticoagulation may be required depending on the valve type used

Lifestyle adjustments: Patients are advised to avoid heavy lifting and high-intensity sports for at least four weeks after the surgery. Instead, they should engage in moderate aerobic activities such as walking or cycling.