Without the aorta, literally nothing works in the body: The main artery, which is approximately 30 centimeters long, supplies practically every organ in the body with blood – i.e. with oxygen, nutrients and fluid. The aorta, as thick as a garden hose, rises briefly from the left ventricle and then curves downward like a cane into the abdominal cavity.
The arteries for the neck, head and arms branch off from the aortic arch at the top, and further down the vessels that supply the abdominal cavity, kidneys or legs. Using sensitive receptors, the aorta can even “measure blood pressure” in the body and is so elastic that it can quickly widen or narrow to allow more or less blood to pass through as needed. Due to its complex structure and its importance for the entire body, the aorta has been considered an independent organ in treatment guidelines for surgeons since the beginning of 2024.
Sometimes, as a precautionary measure during a planned operation, part of the aorta is supported by an inserted tube – a stent – or a section is cut out and replaced by an artificial blood vessel. This is the case, for example, with an aortic aneurysm, a pathological bulging of the aorta that can rupture at some point.
An absolute emergency, on the other hand, is a tear in the aorta (aortic dissection), in which the inner and outer layers of the main artery separate from each other, creating a kind of blood-filled “pocket” that can burst very quickly. Even if the aorta is infected – as was apparently the case with Heinz Hoenig – surgery must be carried out quickly, because an infection can not only cause sepsis (blood poisoning), but can also weaken the vessel walls so much that they can stretch or tear.
If only part of the aorta is pathologically widened (e.g. in the case of an aneurysm) or torn, prostheses made of medical plastic (PET: polyethylene terephthalate) are often used. Such tube-shaped replacement vessels are folded like an accordion (similar to the hinge of a plastic drinking straw) to replicate the flexibility of the aorta. In addition, the prostheses often have connections for the numerous branching blood vessels.
There are different “pieces of pipe”, for example for the ascending and relatively short part of the aorta or for the cane-like aortic arch. Sometimes several pieces of prosthesis are placed together and sewn to the living tissue of the still healthy sections of the aorta.
It becomes more difficult if the entire aorta is damaged – for example due to an infection in the body. Or if a vascular prosthesis that has already been inserted is colonized with stubborn germs. That seems to be the problem with Heinz Hoenig. A continuous prosthesis may then be necessary for the entire aorta, often including the aortic valve that connects the heart to the aorta. Such prostheses are usually tissue donations from dead people. Surgeons can either use an entire aorta or sew together an aortic prosthesis from several donated blood vessels.
Patients often have to take medication before the operation in order to optimally adjust their blood pressure. Depending on how extensive the damage to the aorta is and in which section it is located, surgery is carried out using an open chest or minimally invasive surgery. However, replacing the entire aorta is always a major procedure under general anesthesia that takes many hours.
Interventions on the aorta are often very complex anyway: you cannot simply cut the large blood vessel, which is under high pressure, but must first interrupt and bridge part of the circulation. Even the heart and lungs are “clamped” for a short time. Their work is carried out by a heart-lung machine that sucks the oxygen-poor blood from the large vena cavae that flow into the heart before it reaches the heart. The blood is then enriched with oxygen in the machine and pumped back into the circulation. In this way, the aorta is bypassed and bridged while the surgeons cut out the large vessel or parts of it and replace them with prostheses.
Interventions on the aortic arch are particularly demanding: This is where the vessels for the brain originate, which quickly become damaged without a blood supply. To protect the brain, the blood in the heart-lung machine is cooled down significantly to around 18 degrees Celsius. This puts the brain into a kind of cold sleep and no longer reacts as sensitively to short-term blood circulation bottlenecks.
Replacing large parts or even the entire aorta is a major, life-threatening, high-risk operation – especially for patients who are already weakened by heart disease, an infection or a combination of both.
How many years you gain through the use of an aortic prosthesis depends largely on whether you manage to maintain a healthy lifestyle after the operation. You should minimize your risk to your heart and blood vessels as much as possible, avoid smoking, eat a balanced diet, control your blood pressure and other values with medication and exercise a lot.
