Thoracic Aneurism Surgery follow-up

You do need follow up but will be a cardiologist who does that. I had mine repaired in 2020 and I see my cardiologist every year after an echo. Also mainly because there seems to be propensity in my family he orders full MRIs of my aorta (groin, abdomen and chest) and head every 4-5 years to ensure no new dilations are appearing (I also had a brain aneurysm that was repaired).

I asked him about the graft, there are no concerns about it, but the rest of the aorta is still vulnerable to new dilations, he told me some people develop dilations at the union of the graft and aorta, but it can happen anywhere in my aorta. Maintaining BP under control is critical and that is one of the things he monitors.

If you don’t have one find a cardiologist that specializes in aortic diseases, he/she will know the protocol for your particular case.

You will pretty much be tied to the cardiologist for life.

Wish you the best

Three years out from thoracic aortic aneurysm surgery, it is not typical to have had no follow-up at all. Most patients are followed closely in the first year with imaging (CT or MRI) at 3 months, 6 months, and 12 months to confirm the graft is intact and the repair is stable. After that, lifelong surveillance is generally recommended, though the interval may stretch to every 1–2 years if things look stable. This is because even if your original repair is solid, new aneurysms can develop in other parts of the aorta over time.

The graft in your chest is a Dacron or similar synthetic tube. These are designed to be permanent, and they do not “wear out” or dissolve. True leakage from the graft itself is extremely rare. What doctors watch for are problems at the attachment sites—where the graft is sewn into your natural aorta—or changes elsewhere in the aorta. That’s why surveillance imaging is so important.

It is very normal to not have wanted to know the details before surgery. Many of us go into it in crisis mode and just want it done. But now that you’re three years out, it’s important to establish follow-up. At this stage, you should absolutely have at least a CT or MRI to assess the repair and the rest of your aorta. A cardiothoracic surgeon, vascular surgeon, or cardiologist experienced with aortic disease should be following you long-term.

I went through a Type A aortic dissection myself in 2015, and I live with a Dacron graft in my chest. Like you, I didn’t ask many questions before surgery, but over time I learned that regular imaging and specialist follow-up are the key to staying ahead of problems. Knowing about it lets you be proactive rather than reactive. I get CT scan every year in November and every other year using contrast (it's hard on your kidneys). The contrast give them better definition of the structures but is not necessary every year.

Please schedule an appointment soon with your cardiologist or surgeon to re-establish care. Peace.

Both comments have been extremely helpful. Thank you for taking the time to answer me.
I did know I should keep my blood pressure down, but rarely check it. When I do it can be in the 150's to 160's and that is alarming. I was taking 50mg metoprolol 2X/day and 10 mg of ramipril 1X/day, but quit the ramipril long ago (I forget why. I think I felt way too tired.) obviously my metoprolol alone isn't keeping my blood pressure down.

I took them at Metopropal and really had problems with it. It made me goofy when I exercised. I am on amlodipine, carvedilol and atorvastatin for the past 9 years and its been great. Peace.

Your target BP should be around 120, definitely need to find a way to lower it, your cardiologist should be able to find the right combination of medications for you. I personally take Losartan and Hydrochlorotiazide in the morning and Metoprolol in the evening

My surgery was Sep 10, 2024. I am at Mayo today getting a CT with Contrast and Echocardiogram. Tomorrow I see my Cardiologist at Mayo.

What was your symptoms with the Metoprolol? I have been on 12.5mg morning and 12.5mg night since surgery last September. I am also on 20 mg olmasartin. When I crouch or get up and down from a low position, I experience orthostatic hypotension with my BP dropping into the 80s over 50s. The past week we cut back the olmasartin to 10mg but hasn't really solved the problem.

It made me almost zombie-like when I walked. I would go for a walk of say 1 mile and by the 1/4 mile mark I was walking funny, Zombie-like. Think ragdoll. Floppy arms and legs. Exaggerated movements. It didn't hurt but it scared my wife and kids. It was only when I exercised that it kicked in.

When I was on Metoprolol, it slowed my heart down so much that whenever I tried to exercise, my body couldn’t keep up with the extra demand. At rest I felt fine, but once I got moving—say a quarter mile into a walk—my heart wasn’t able to speed up the way it normally should. That meant less oxygen and blood flow getting to my muscles and brain, and that’s why my gait would turn floppy and “zombie-like.” It wasn’t pain or injury, it was the drug blunting my circulation when my body actually needed more.

What was happening is that Metoprolol, being a beta-1 blocker, keeps the heart from increasing its output the way it should during exertion. So while my muscles and nervous system were calling for more supply, the medication was holding that back. That mismatch is what caused the ragdoll effect my family saw. My doctor switched me to Carvedilol because it works a bit differently. It still protects the heart, but by also blocking alpha receptors it allows for smoother blood pressure control and better blood flow to the rest of the body. In practice, that means I can be active without feeling those strange, exaggerated movements, and still get the heart protection I need. Peace.