Healthcare Delivery

Surgical Case Study: Dr. Pramod Reddy, Medicover Hospitals treats a patient with Aortic Dissection through the Frozen Elephant Trunk Technique

A young male student of 20-years from Nagpur reported with Aortic Dissection with Marfan Syndrome – an inherited disorder that affects the connective tissue at Medicover Hospitals, Hitech City Hyderabad. Aortic dissection is a medical emergency in which the inner layer of the large blood vessel branching off the heart (aorta) tears. Patient presents with severe chest or upper back pain that radiates to the neck or down the back, loss of consciousness and shortness of breath.

Aortic dissection is relatively uncommon. The condition most frequently occurs in men in their 60s and 70s. An aortic dissection occurs in a weakened area of the aortic wall. Chronic high blood pressure may stress the aortic tissue, making it more susceptible to tearing.

Dr Pramod Reddy, Medicover Hospitals Hyderabad explaining the procedure

Also seen in people born with a condition associated with a weakened and enlarged Aorta, such as Marfan syndrome, bicuspid aortic valve, or other rarer conditions associated with weakening of the walls of the blood vessels. Aortic dissection can quickly lead to death from not enough blood flow to the heart or complete rupture of the aorta.

Dr Pramod Reddy, Chief Cardiothoracic and Aortic Surgeon, Medicover Hospitals and teamcarried out this complex procedure by replacing half of the aorta from the aortic root by using new technique called FROZEN ELEPHANT TRUNK. The complex nature of the procedure is that the main arteries which supplies blood to the brain and heart are present in the affected part and requires precision care and expertise to repair and replace the aorta from the root.

The images of the procedure, before the surgery and after repair, as you can see the dissection has been treated

Dr Pramod further explained that the patient is required to be put under Deep Hypothermic Circulatory Arrest – which means cooling the patient’s body to a temperature of around 18-20 degrees and stopping blood circulation to the entire body except the brain for a period of 45 minutes.

“Mortality rate in such cases is 30-40%. There is also a chance of a stroke and Paraplegia.

Dr Pramod Reddy, Chief Cardio Thoracic Surgeon, Medicover Hospitals, Hyderabad

The entire procedure is expected to be done during the window of Deep Hypothermic Circulatory Arrest and any delay would result in losing the patient.

Dr Pramod Reddy & the team successfully carried out the procedure and stabilized the patient. The patient is now recovering and would soon be leading a normal life.

Very few centers across the globe perform this surgery. Usually, this procedure is done in a two-stage process, but we were able to successfully manage the whole procedure in a single stage which is done by using a special tube with a stent. (FROZEN ELEPHANT TRUNK TECHNIQUE). This technique reduces the necessity for subsequent additional operations and therefore may improve long-term survival.

(This case study has been developed by Dr. Pramod Reddy and his team at Medicover Hospitals, Hyderabad)

Healthcare Delivery

Surgical Case Study: Medicover Hospitals-Transcatheter Aortic Value Replacement (TAVR)

(Below is a case study from the Medicover Hospitals in Hyderabad)

A 65-year-old male with systemic hypertension presented with Class II DOE. He had undergone IVUS-guided PTCA to LMCA and mid LAD along with PTA to left ICA in 2015. He has a history of peripheral artery disease (right leg claudication), severe restrictive and obstructive lung defect, and S/P right iliac stenting (2015).

2D Echo showing calcified bicuspid Aortic valve

Further evaluation of the echocardiography revealed a bicuspid aortic valve with severe calcified aortic stenosis. He approached us for transcatheter aortic valve implantation/replacement (TAVI/TAVR). Transcatheter aortic valve replacement was a necessary option due to his high-risk surgical profile (renal dysfunction, COPD, bicuspid valve, and coronary status) and to improve his quality of life.

CT with Aortic valve dimensions

After discussion with the Heart Team (Interventional Cardiologists, Cardiac Surgeons, and Cardiac Anaesthetists), we decided to go ahead with TAVR under conscious sedation due to poor lung function. After thorough CT analysis, we proceeded with a 23 mm Sapien-3 valve, which was deployed through the femoral artery.

We used Preclose ProGlide Closure device to manage the arterial puncture site. The procedure was completed within an hour and a half, and the aortic valve gradient reduced from 107/70 to 20/11. The aortic valve was replaced in a single sitting without the need for coronary revascularization and conversion to open-heart surgery. He was mobilized within two days and discharged on day 5.

Coronary Angiographic image showing Transcatheter Aortic value implantation of 26 mm Sapiens -3 valve

TAVR is an excellent alternative for all patients with high surgical risk (STS score > 4, Logistic Euro Score > 10, Re-do surgery and post-chest radiotherapy patients, and patients with multiple-organ dysfunction).

Authorerd by  Dr. Sharath Reddy & Team, Medicover Hospitals, Hitech City, Hyderabad