Major hybrid aortic surgery done at MMM on a patient from Myanmar

• The patient had a large aortic aneurysm putting him in danger of a rupture at any time.
• He had complained of chest pain, sleeplessness and breathing difficulty.
• The frozen elephant trunk method was used to insert a special stent cum tube graft.
• This procedure is done only at advanced cardiac centres due to the complexity and risks
• The patient has recovered and was discharged within ten days.

Chennai, March ‘24: Doctors at MMM – a team headed by Dr. Vijit Cherian, Director - Minimally Invasive Cardiac Surgery & Heart Failure - operated on a 55-year-old from Myanmar who had come to the hospital with a case of a large and extensive aortic aneurysm. 

The symptoms that the patient showed were chest pains, breathlessness and he also had problems sleeping. He was diagnosed to have a very large aortic aneurysm for which the doctors in Myanmar recommended that he seek medical help elsewhere for as they did not have the capacity to deal with this.

“There was a large aneurysm starting from the heart with the aortic valve and the aorta in the thorax being completely affected. The patient was in grave danger of a catastrophic rupture in the heart that would almost surely result in death. Complicated aortic aneurysms are difficult to treat and many a time have a difficult time after the operation as there could be many organs affected by this surgery as it interferes with their blood supply. Often, such cases also come with complications due to the extent of the disease and the complex treatment options,” said Dr. Ezhilan, HOD, Peripheral and Vascular Department. 

Surgery: This surgery involved the replacement of the aortic valve, followed by the entire aorta of the thorax - except the terminal part of the aorta in the thorax. 

Dr. Vijit Cherian, Director - Minimally Invasive Cardiac Surgery & Heart Failure, said, “The latter procedure required an endovascular stent and was done in phases. It was done using a special tube with stent that was placed using the Frozen Elephant Trunk method. This is a complex technique which ensures that most of the replacement of the aorta can be achieved in a short time and it also reduces the necessity for subsequent additional operations.”

“The operation took about eight hours with the assistance of the heart lung machine. The procedure involved the patient’s body being cooled to a temperature of around 18-20 degrees centigrade and stopping blood circulation to the entire body except the brain for a period of 30 minutes,” he further added. 

There are very few advanced centres across the country that have the requisite experience in the use of this stent-graft hybrid. 

The limitation of the treatment was that only about 80% of it could be done in one stage. However, this still is very good as a couple of decades ago, this treatment would entail multiple procedures with high possibilities of morbidity and mortality.

With the high levels of technology involved, the risk to life in this surgery is still in the region of 10 -20%; a possible unintended outcome of this surgery could also be a stroke.

“The patient recovered in the postoperative period within 3-4 days, having recovered with little supportive treatment, with no deficits in the functioning of any of the major organs. He came in later for the remaining stage of the treatment where the lower portion of the aneurysm was treated with the help of an endovascular stent. The patient has since returned to Myanmar and is getting back to normal life,” said Dr. Aashish Chopra, Adult Cardiologist.

He is only required to have his medications, much like any other patient post a cardiac procedure. 

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