The disease is as complex as its surgical correction. And a frozen elephant trunk technique is what saved the day.
Thirty-six-year-old Ramesh Babu was rushed to MIOT Hospitals with the weakest pulse, excruciating back pain and breathlessness in February last. It was not the first time he was entering the hospital, though. His weak aortic wall ensured that he was in and out of hospitals. The last time he was in MIOT was in late 2005, where the team did a procedure on him, replacing the aortic valve and the base of the aorta, the root.
“What he had was what we call a ‘type A' dissection of the aorta right down the length of the major blood vessel,” explains V.V. Bashi, chairman, MIOT Centre for Thoracic and Cardio Vascular care. In an aortic dissection, a potentially life-threatening condition, there is a tear in the main blood vessel which leads to bleeding into and along the wall of the aorta. This leads to two channels being formed in the aorta itself.
Dr. Bashi further clarifies: Five per cent of patients die within an hour. Prolonging the surgery only increases the chances of death. With Ramesh Babu, the CT scan showed that two complex problems had to be addressed: the arch portion of the aorta, and its descending portion, had ballooned with the leaking blood; and the narrowing of the portion of the blood vessel actually pumping blood to the rest of the body.
These two problems conventionally will be remedied by a two-stage operation. “But this creates additional risk for the patient; and brings on the associated problems of two surgeries,” Dr. Bashi explains. This is when the ‘elephant' entered the picture.
A hybrid graft “Evita,” currently in use only in Europe, was used for the first time in India in a single surgery, correcting both problems. An open heart surgery was scheduled; the chest was opened and the patient connected to the heart lung machine. His blood was cooled; and circulation stopped to the lower part of the body, while the brain continued to receive the cool blood. The graft was deployed inside the descending end of the aorta, by interventional radiologist K.Murali, and then drawn out through the arch to the other end. The other end of the graft was used to suture the vessels that go to the head and neck. “Only 100 such grafts have been used the world over the last three years, and those results have been good. It is ideal for a single stage correction. The whole graft resembles the trunk of an elephant, but this one is called ‘frozen' because it is reinforced with pliable metal which gives it its form,” Dr. Bashi explains.
The surgery was only possible because of a team effort, Dr. Bashi says. He was assisted by V. Harilal, Kannan R. Nair, interventional cardiologist K. Sivakumar, anaesthesiologists Aju Jacob, Jyotsna and Shankar, besides a whole host of perfusionists, nurses and technicians right through the six-hour operation.
