Resection with End-to-End Anastomosis

The aorta is the largest blood vessel that branches off your heart and delivers oxygen-rich blood to your body. Coarctation of the aorta is a type of congenital heart defect (present at birth) in which the aorta is narrowed. When this occurs, your heart must pump harder to force blood through it. If left untreated, this condition can lead to severe hypertension, stroke, coronary artery disease or aortic dissections.

Treatment options depend on your age at the time of diagnosis and the severity of your condition. Based on these, your doctor will decide at what stage in your life to proceed with surgery. Treatment options include resection with end-to-end anastomosis, subclavian flap aortoplasty, bypass graft repair, and patch aortoplasty. These options can be performed through open-heart surgery (involves dividing the breast bone / general anesthesia). Sometimes the coarctation is better repaired by an incision in the left chest.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.

How to Prepare for the Procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Diabetes and how to adjust your medicine on the day of the procedure.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any implanted device (e.g. pacemaker or ICD).
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before the Procedure

Before the procedure, your doctor may perform a variety of diagnostic tests, including:

• Echocardiogram (ECHO)
• Cardiac catheterization
• Computed tomography (CT scan)
• Magnetic resonance imaging (MRI)
• X-Rays
• Electrocardiogram (EKG/ECG)

What to Expect During the Procedure

If resection with end-to-end anastomosis is required, this method will usually take between 3 to 4 hours to complete, but preparation and recovery may add several hours. The procedure is usually performed in the cardiothoracic operating room (OR). Check with your doctor about the details of the procedure. In general:

• Once sedated, your doctor will insert a breathing tube through your throat into your lungs and connect it to a ventilator. This will breathe for you during surgery.
• Your doctor will administer general anesthesia (will make your feel sleepy).
• The procedure begins when your doctor exposes your heart by dividing the breastbone (sternum) in half. Your doctor then spreads both halves to gain access to your heart (open-heart surgery). However, sometimes the surgery can be done by cutting through the left chest wall.
• For this type of open-heart surgery, the heart may need to be still. Prior to doing so, your doctor will place tubes into your heart so that blood can be pumped through your body by use of a heart-lung machine. This machine takes over for the heart by replacing the heart’s pumping action and the lungs by adding oxygen to the blood. If surgery is done from the left chest, the heart-lung machine is not necessary.
• Once the blood has been diverted into the bypass machine for pumping, your doctor will then stop the heart by injecting it with a cold solution.
• When the heart has been stopped, your doctor will start with the procedure by removing the narrowed segment of the aorta (resection).
• Your doctor will then connect the two ends of the aorta together (anastomosis).
• After the procedure is completed, the doctor will closely check to make sure everything is working properly. Once checked, the doctor will let the blood circulating through the bypass machine back into your heart.
• Once the procedure is complete, the machine will be turned off. The tubes will be removed and the sternum will be sewn together with the use or sutures or surgical staples.

What to Expect After the Procedure

After the procedure, you will be taken to the cardiothoracic intensive unit (CTICU) for further observation for several days. Other recommendations include:

General Guidelines

• The breathing tube is removed when you wake up from anesthesia.
• Diet is started the day after surgery with liquids, and quickly advanced to solids as tolerated.
• Ambulation is started on the first or second day of surgery.
• Urine catheters and drainage tubes (chest tubes) are removed after 24 to 48 hours.
• Nurses, respiratory therapists, and physical therapists will work with you as you begin physical therapy and breathing exercises.
• Your doctor will give you instructions to follow during your recovery.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.