KOCHI: Doctors at a private hospital in Kochi have successfully performed a major and risky hybrid procedure using a frozen elephant trunk (FET) stent-graft to save the life of a 59-year-old patient airlifted from Sri Lanka.
Shane Bernard Croner was admitted in a hospital in Colombo with central shearing chest pain and intractable hypertension. Even after treatment, the patient, a native of Colombo, continued to have life-threatening and uncontrollable blood pressure.
The CT scan images were shared with Dr Rohith Nair, consultant interventional radiologist, Aster Medcity in Kochi. On reviewing the CT images, doctors at Aster Medcity confirmed an aortic dissection, a serious condition in which the inner layer of the aorta, the largest artery in the body, tears. The dissection had also extended towards the heart, stopping just short of the coronary arteries.
A core team comprising Dr. Manoj Nair, lead CTVS surgeon; Dr Suresh G Nair, sr. consultant lead, CTVS Intensive Care; Dr. Rohith Nair and Dr. Johnson, ED consultant, was formed immediately.
The medical team recommended immediate shifting of the patient to Aster Medcity. But shifting of the patient was difficult due to strict COVID-19 restrictions in place in Colombo where the patient was hospitalised. Dr. Rahul Singh and his ICATT air-ambulance team were roped in to oversee the pre-transfer optimization of the patient and the logistics. The patient was then airlifted to Aster Medcity in Kochi.
A repeat CT imaging conducted at Aster Medcity, Kochi, showed an enlarging false lumen in the thoracic aorta with a paper-thin true lumen threatening the arterial supply to the right kidney and bowel.
An urgent multidisciplinary meeting held has concluded that frozen elephant trunk stent-graft procedure was the only option to save the patient’s life. “The FET has two components -- a soft graft component and a stiff stent (frozen) component. In the early days, such retrograde Type A dissections were managed by a hemi arch replacement with a plication of the true and false lumens with very high morbidity and mortality rates. FET is a major advancement in the management of such complex cases,” said Dr. Manoj Nair.
He added that the stent-graft and the devices were urgently flown in from Mumbai. In the hybrid cath lab, a wire was passed into the true lumen of the aorta via the right femoral artery to prevent the true lumen from collapsing and compromising blood supply to the patient’s organs.
A medical team comprising Dr. Manoj Nair and Dr. George Varghese Kurien, CTVS Surgeons, established an intricate bypass circuitry to enable adequate blood flow to all the vital organs.
Then the diseased ascending aorta and arch were explanted. Dr. Manoj and Dr. George sewed the graft to the native aorta, which involved multiple suture lines. The procedure lasted for 14 hours and the vital organs including brain and kidneys were given blood supply through selective tubes placed into them during the procedure. All the vital organs recovered well after the surgery. The whole body was cooled to prevent damage during this long surgery (hypothermia technique).