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Press Meet on - A Breakthrough in the Surgical Treatment of Dissecting Aneurysm of Thoracic Aorta – Frozen Elephant Trunk Operation Using Hybrid Graft” held at Miot Hospitals – 09th March 2011
A team of doctors headed by Dr. V.V. Bashi did a complex redo surgery on a 39-year-old male from Tamil Nadu. This patient came to MIOT hospital on 4.11.2005 with history of sudden excruciating back pain with high blood pressure as an emergency. He was diagnosed to have type ‘A’ dissection of the aorta extending upto aortic bifurcation with a major leak in the aortic valve. He underwent a major emergency operation to replace the aortic root and aortic valve after which he was on regular follow up because of his distal aortic dissection.
Three weeks ago he presented to MIOT Hospitals with severe back pain, which was not relieved with any medications. He underwent 64-slice CT aortogram which showed the following abnormalities.
- A large aneurysm involving the aortic arch and descending thoracic aorta which was leaking.
- Narrowing of the aorta due to dissecting aneurysm.
Normally, this can be corrected only by a two-stage operation, which carries the risk of two operations and its associated problems. In this case, a hybrid graft called EVITA was used, using the Frozen Elephant Trunk technique. This hybrid graft is the latest available in the world and was done for the first time in India.
DETAILS OF THE OPERATION
Since the patient had a leaking aneurysm which was about to rupture, he was taken up for an emergency operation. His chest was opened after which he was connected to heart-lung machine. Blood was cooled to about 20°C. Then we stopped the circulation to the lower part of the body and started antegrade circulation to the brain. Introduction of the EVITA graft was done to the distal dissected thoracic aorta under fluoroscopy with Endovascular technique. The other end of the graft was used to suture the arch vessels for normal brain circulation. After the operation was completed the patient was disconnected from heart-lung machine. He had an uneventful postoperative recovery and he is getting discharged today.
This case is presented to show that acute dissection of the aorta can be operated in a single stage using the new graft. Even though various techniques have been described for the treatment of aortic dissection, this hybrid graft seems to be the best of its kind as of today. Only 100 of these grafts were used as on today all over the world and the long term results are very encouraging. This is used for the first time in India successfully in this case. Use of this hybrid graft with Frozen Elephant Trunk technique will help lot of patients in our country with dissecting aneurysm.
The surgical team was headed by Dr. V. V. Bashi, assisted by Dr. Harilal and Dr. Kannan R. Nair, Dr. Dilipkumar, Interventional Radiologist Dr. Murali, Anaesthesiologists Dr. Aju Jacob, Dr. Jyotsna and Dr. Shankar. Besides this a team of dedicated perfusionists, nurses, and technicians assisted the operation which lasted for 6 hours.
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Welcome speech by Prof. Dr. P.V.A. Mohandas – Managing Director – MIOT Hospitals -
Case presentation by Dr. V.V. Bashi - Chairman - Centre for Thoracic and Cardio Vascular Care – MIOT Hospitals -
Case presentation by Dr. V.V. Bashi. -
Interaction with the Press fraternity – (from left to right): Dr. Murali – Interventional Radiologist – MIOT Hospitals; Prof. Dr. P.V.A. Mohandas – Managing Director – MIOT Hospitals; Dr. V.V. Bashi - Chairman - Centre for Thoracic and Cardio Vascular Car -
During the interaction with the Press fraternity -
During the interaction with the Press fraternity -
During the interaction with the Press fraternity -
During the interaction with the Press fraternity