This First Hours in ICU After Aortic Surgery ~ The African Perfusionist Emmanuel Mbaka

AORTIC HOPE | NOVEMBER 2026

The First Hours in ICU After Aortic Surgery What Patients and Families Should Expect By Emmanuel Mbaka | The African Perfusionist

The operation is over.

Your family has been told that the surgeon has completed the repair.

Perhaps an aneurysm has been repaired, part of the aorta replaced with a graft or an aortic dissection treated. For the first time in hours, loved ones may feel relief. But then comes a moment many families are not prepared for: transfer to the intensive care unit (ICU).

There are monitors, tubes, medications and nurses watching closely. You may still be asleep. Your family may wonder why you have not woken up.

What actually happens after aortic surgery?

The Journey From the Operating Room to ICU Once surgery is completed, the team checks that circulation, breathing, bleeding and other vital functions are sufficiently stable for transfer. The anesthesiology and surgical teams give the ICU team a detailed handover about the repair, the operation and any concerns requiring close attention. Many patients arrive in ICU still asleep, with a breathing tube connected to a ventilator. This does not automatically mean something has gone wrong. After major aortic surgery, the body needs time to recover from anesthesia and the effects of the operation. The ICU team continually assesses when sedation can be reduced and breathing support removed.

Why Are There So Many Tubes and Machines?

The equipment can be overwhelming when families first see a loved one in ICU. Each device has a purpose.

• Breathing tube and ventilator: Support breathing until the patient can breathe safely without assistance. Some patients have the tube removed within hours; others need longer, especially after complex surgery or complications.

• Chest drains: Remove blood and fluid from the chest. Staff monitor drainage closely because excessive bleeding may require further assessment or treatment.

• Monitoring lines: An arterial line provides continuous blood pressure readings and allows blood sampling. Intravenous lines deliver fluids and medicines. After aortic repair, careful blood pressure management helps maintain organ perfusion while protecting the repair.

• Urinary catheter: Measures urine output as one indicator of kidney function and circulation.

• Temporary pacing wires: Some patients have these to help manage certain heart rhythm problems if needed.

Not everyone has every device.

Equipment is removed as the patient improves.

What Is the ICU Team Watching?

The team is monitoring the entire body, not just the heart.

• Heart and circulation: Blood pressure, heart rhythm and signs that organs are receiving adequate blood flow. Some patients need medications to support circulation or control blood pressure.

• Bleeding: Chest drainage, blood counts and clotting are followed closely, particularly after extensive repairs or prolonged cardiopulmonary bypass.

• Brain: Neurological assessment is especially important after aortic arch surgery or surgery for dissection. As sedation is reduced, staff assess waking, ability to follow commands and limb movement.

• Kidneys: Urine output and blood tests help detect kidney problems. Lungs: Oxygen levels, breathing and readiness to come off the ventilator are assessed repeatedly.

Waking Up After Surgery Waking up may not be a single clear moment. You might hear voices before opening your eyes, feel confused about where you are or notice a tube in your mouth that prevents you from speaking. Staff will explain what is happening and reassure you. Temporary confusion or delirium can occur after major surgery. Medications, disturbed sleep and critical illness may contribute. Persistent or concerning changes need medical assessment.

The breathing tube is removed when the team judges it safe—not according to a fixed clock.

The First 24 Hours

The early focus is stabilization and close monitoring. The team may reduce sedation, assess breathing, adjust medications, monitor drainage, manage pain and plan the next steps. Blood tests and other investigations guide decisions. When appropriate, assisted sitting, breathing exercises and gentle movement may begin. A planned ascending aortic aneurysm repair may follow a very different course from emergency surgery for an acute dissection. The procedure, the patient's health before surgery and any complications affect recovery. There is no single timeline for everyone.

When Recovery Takes Longer Some patients need prolonged breathing support, circulation medications, treatment for bleeding or closer monitoring of kidney or neurological function. Occasionally, further procedures are necessary. A longer ICU stay does not automatically mean the operation failed, but it does mean the patient needs continued assessment and support. Families can ask what concerns the team is monitoring and what goals they have for the next day.

What Families Can Do

When visits are permitted, speak calmly to your loved one, even if they are sleepy. Remind them where they are and, if confirmed by the team, that surgery is over. Ask staff how you can help.

Useful questions include:

• How is circulation doing?

• What needs to happen before the breathing tube can come out?

• Is bleeding a concern?

• How are kidney function and neurological assessments?

• What are the goals for the next 24 hours?

The ICU team may not be able to predict exactly when someone will wake, leave ICU or go home. Recovery is evaluated step by step.

A Message From the Operating Room

As a perfusionist, I help support circulation with the heart-lung machine while the surgical team performs complex repairs. Some aortic operations also involve carefully controlled cooling and specialized techniques to protect vital organs. But the operating room is only one part of the journey. When a patient leaves theatre, ICU nurses, intensivists, anesthesiologists, surgeons, respiratory professionals and other specialists continue the work of protecting the patient and supporting recovery. For families, it may feel as though the hardest part is over when the operation ends. For the patient, another important phase has begun.

The ICU is not simply a place patients go after surgery. It is 10:00where the team continues watching, supporting and responding as the body begins its recovery.

One step at a time, the journey continues.