What happens the day of surgery?
In the 24 hours leading up to surgery, you should not eat or drink past midnight the night before. You will also need to shower with special antibacterial soap that we provide the night before and the morning of surgery.
On the day of surgery, you will check in on the third floor of the Milstein Hospital Building and be brought to the fourth floor, where the operating rooms are located. Your surgeon and anesthesiologist will explain the procedure in detail and answer any questions you or your family may have before you are brought into the operating room and placed under general anesthetic. Once you are asleep, the surgeon will begin the operation.
What will anesthesia for aortic surgery involve?
Anesthesia involves putting you to sleep for the surgery so you do not feel any pain. Your anesthesiologist will place an intravenous line in your wrist or arm to administer anesthetic medication and antibiotics, an arterial line in your wrist to monitor your blood pressure throughout the procedure, and a breathing tube in your mouth to help you breathe. An anesthesiologist will be present throughout the procedure to monitor your vitals and adjust your medications accordingly.
Please note that you should let your anesthesiologist know before the procedure about any loose teeth or the presence of dental work such as bridges, dentures, or loose teeth – these may interfere with the breathing tube – or any neck problems. It is also important to tell your anesthesiologist whether you have had problems with general anesthesia in the past.
How do you make sure my body gets enough oxygen, if my heart’s not beating?
Aortic surgeries can involve rebuilding the aortic arch, which requires alteration of the normal blood blow throughout the body. Since blood flow to the brain must continue at all times to ensure patients' safety, our surgeons continuously monitor oxygen levels in the brain using non-invasive oximetry pads placed on the scalp.
The surgical team uses antegrade cerebral perfusion (ACP) rather than circulatory arrest to maintain blood flow to the brain, which minimizes the risk of stroke. In this technique, an axillary artery is attached under the collarbone in order to allow blood to continue to perfuse the brain via the heart-lung machine in a forward, or antegrade, flow. Traditionally, it is the femoral vessels in the thigh that are cannulated, or linked, to the heart-lung machine, which makes the blood take a backwards route to the brain.
ACP is a beneficial approach because it reduces the risk of stroke that comes with retrograde flow, further protecting the brain from neurological damage. To date, more than 500 axillary cannulations for a range of aortic surgeries have occurred at the Aortic Center, with no injuries to axillary vessels or nerves and a much lower rate of stroke compared to the national average.
How long will my surgery take?
Operations on the aorta typically take 3-6 hours. Additional time will be required for anesthesia and to move you from the OR to the ICU. Your family members will be allowed to visit you about an hour after the surgery, though you will be asleep at this time. The anesthesia wears off after several hours, at which point you will wake up in the ICU.