Surgery to Repair Your Aorta

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic, and vascular systems, ways to stay healthy, and information about diseases and treatment options. Enjoy.

Dr. Milind Desai:

You found the aneurysm. It's time for surgery. Dr. Vargo, what to expect?

Dr. Patrick Vargo:

Thank you. I'm one of these plumbers that change out a lot of pipes, and bad valves, and whatnot. I'm one of the heart and aorta surgeons. So the aorta is, as many of you know or have learned firsthand, the big vessel in your body that takes blood out of the heart and is a tree trunk that delivers it to all the limbs that go throughout the body. And it exists in three major areas in the chest, right by the heart in the front, in the chest along the spine in the back, and in the abdomen along the spine as well.

And so, depending on where the problem is, where the area of disease, is where we go to first. The goals of surgery, whether it be elective and planned, or whether it be an emergency that you're transported and rapidly forced, to go to the area where the aneurysm is the biggest, or where the tear is rupturing and bleeding internally, and to go there and replace that piece of aorta, that piece of tube, with a cloth graft or realign it with a stent to stabilize it.

The goals of the surgery are essentially to stabilize the area that's weakened and bleeding, and prevent it from bleeding internally, to stabilize the wall of it. And in the case of these emergency dissections, where sometimes blood flow is compromised to the area of the body, the brain and organs, it's to stabilize that and make sure blood continues to get to where it needs to go, to the organs that keep us alive.

Depending on where it is can mean a lot of different things. It can mean an incision in the front, open heart surgery, using a heart and lung machine. It can mean an incision in the side to get to the aorta as it runs along the spine and the chest, or it can mean an incision in the belly to get to the aorta that's in the abdomen. And increasingly so, we're developing different technologies that are allowing minimally invasive and lesser invasive techniques.

So sometimes we can do this with a needle poke in the groin, and use wires and x-rays to deliver stents without a major incision. All of these things with the old-fashioned tube grafts, where we cut out a piece of bad aorta and sew in a tube in its place, or the stents that we use to realign them, allow us to use both these things to help patients out. The cloth ones are the canvas hoses that we use to sew in, or the spring loaded stent ones that realign the inside of the aorta, kind of like a new inner tube.

One thing these different devices and things have really allowed us to do is that, instead of the old fashioned thinking, go to where the problem is, cut it out, and then get out of dodge, we're doing a little more extensive repairs or doing a little bit more planning at that time to think about the next step. Because as we're discussing this up here, the aorta, it's a long tube and we're fixing one part of it, but it's all made out of the same stuff.

And just because it's abnormal in one spot, it may be abnormal in another. So these devices allow us to set us up for the next procedure if you need it. It may make it the next procedure also lesser invasive as well. And there's some early data to suggest that maybe these slightly more extensive operations in the appropriate patients may actually save lives and prevent future emergencies and improve survival.

We're working very closely both with our cardiologists and internal medicine doctors here to surveil these and intervene electively when there's growth or large size to begin with. We also work closely across surgical disciplines. So me and Dr. Caputo and his partners, me and Dr. Roselli, we do a lot of these surgeries together because we each have our area of expertise. And we really want to treat the whole aorta, and keep the whole aorta in mind when we're planning these operations.

Dr. Milind Desai:

Dr. Vargo mentioned about the surgical approach, but it is important, surgeries work, but in the long run, also having a game plan of doing the other things, your weight, your cholesterol, your blood pressure, your heart rate, your stress level, all those things need to, this is a team sport, and all these players need to be engaged in this.

Dr. Vidyasagar Kalahasti:

Just to add to that is the lifestyle. I think one of the most important questions that patients ask after their recovery is, what can I do? And what should I not do? And how best I can optimize my health overall? I think that becomes a very individual patient discussion because everybody does things differently. What suits one person may not suit the other person. So that's, again, important to bring it up. And when you see physicians, ask all those questions specifically about activities, and restrictions, and things like that.

Dr. Eric Roselli:

But don't let anybody restrict you too much. Aorta's that fragile? Vargo will fix it yesterday. We'll make sure you're getting your recommendations from somebody who's comfortable and confident taking care of aortic problems.

Dr. Milind Desai:

In general, there is no restriction to moderate aerobic activities. A lot of times, just sit in your dark corner in your house and don't do anything. That's terrible advice. Your blood pressure is going to go up, your weight is going to go up, everything is going to be in a bad spiral.

Dr. Vidyasagar Kalahasti:

Just to add one more point to that: Marfan Syndrome usually used to not let people live beyond a certain age more than two, three decades ago. So from a surgery standpoint, most Marfan patients who are born now can have a normal lifespan. One of the things that we are recognizing is that all the chronic diseases that affect other people, affect Marfan patients too.

Dr. Milind Desai:

Exactly.

Dr. Vidyasagar Kalahasti:

So just because they're living a longer life, they are at the same risk as everybody else. And if we restrict people from doing what they want to do, you're actually going to increase their morbidity and have more chronic diseases happen to them. So, it's very important to not be sedentary, find an activity that suits you, and be very active.

Dr. Eric Roselli:

I think what you said about personalizing is really important. So you don't, mind you don't have Marfan's, you had an aortic dissection. If there's a part of your aorta that's sort of vulnerable and worried about, and we're watching a little bit closer, we might tell you to back off of some things a little bit. If we've fixed a whole bunch of it, and a whole bunch of it that we're monitoring with surveillance imaging looks really great, I'm going to tell you to go for it. But we don't want anybody to be a power lifter who's had an aortic dissection.

Dr. Vidyasagar Kalahasti:

Yes.

Dr. Milind Desai:

Things you learn in practice. So it's sort of like you tell a patient, "Don't lift beyond 50 pounds." They're going to be great about not doing that in the gym. But then you ask them a question, "Where did you go on vacation last year?" "Oh, we went on a cruise," wherever. "Did you help your spouse lift that heavy suitcase up?" "Oh yeah, of course. I'm not going to let my wife do that," or my spouse. That's a problem. Most dissections don't happen in the gym. Most dissections happen when you least expect them. So simple little things that you have to think about.

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