Carotid artery cannulation keeps blood to the brain flowing during aortic dissection repair.
About the Patient and condition:
A 52-year-old gentleman suffered from a condition where the Aorta (the main vessel arising from the heart and supplying blood to the entire body) had accidentally suffered a tear between its walls. This is a very serious condition and the chance of death increases by 1% with every hour till surgery is performed.
Patient complained about back pain during exercise at night in the middle of lockdown for COVID-19. He was taken to a local nursing home in North Kolkata where CT Scan of the chest was done which raised suspicion of Aortic Dissection as well as a strong suspicion of COVID Pneumonitis. He was admitted at Apollo Gleneagles Hospitals, Kolkata with an obtunded mentation with deranged kidney function and paralysis of both lower limbs. COVID status was cleared with two negative tests. He was taken up for surgery the following day, after explaining the high risk to his wife.
Intra-operatively the extent of tear in the Aorta was more than what was revealed in CT Scan. A tube was sewn into Carotid Artery (the vessel supplying the brain) which was used to maintain brain blood flow while the entire body was devoid of blood and the heart was stopped during the surgery. His Aortic valve was repaired, the dissection was repaired and the entire Ascending Aorta was replaced. The procedure was briskly performed while the patient was cooled down to 18 degrees centigrade.
The surgery was uneventful. After the procedure, the patient was singing on the third day — an event that the nurses recorded out of sheer delight. Also, in such cases, usually patients have to stay in the hospital for three or four weeks. However, in this case, the patient went home in just six days.
Aortic Dissection is a life threatening grave condition where the mortality is around 50%, even in the best centers across the globe. Brain protection is the major challenge and several strategies have been formulated for this. The common practice among surgeons worldwide is to cool the patient to 18 degrees to reduce the blood and nutrient requirement of all organs of the body including the brain. However, maintaining uninterrupted blood flow to the brain during surgery has proven to produce superior results than otherwise. Carotid artery cannulation is the best technique documented so far. However, due to surgical complexity this technique is mostly avoided by surgeons across the globe.
Expertise at Apollo Hospitals:
Apollo Gleneagles Hospitals, Kolkata is the first hospital in Eastern India to successfully perform Carotid artery cannulation. Patient had a successful post-operative recovery and was discharged home after 6 days. “The advantage of cannulation from the carotid artery over the other sources are that the arterial access is rapid. It is relatively easily done and provides adequate circulation during the surgery.” said Dr. Sushan Mukhopadhyay, Director and Senior Consultant, Cardiothoracic and Vascular Surgery, Apollo Gleneagles Hospitals, Kolkata.
Apollo Hospitals – Touching Lives:
The entire Cardio-thoracic team of Surgeons, Anaesthetists and Perfusionists at Apollo Gleneagles Hospitals, Kolkata were involved in the complicated surgery. It was a coordinated and synchronised process and the credit goes to the whole team. The surgery was of complex nature and the primary challenge was to maintain blood flow to the brain while the patient is on Heart-Lung machine, the heart is stopped and the entire blood of the body has been drained out for surgery. This technique is known as Total Circulatory Arrest and the patient is cooled down to 18 degrees centigrade. There was a risk of post-operative neurological dysfunction along with consequences of deep hypothermia.
However, our Cardio-thoracic team performed the surgery meticulously and gave a new lease of life. The team at Apollo Gleneagles Hospitals, Kolkata are known for performing such challenging surgeries which no other centres perform.
“We had lost all our hope. But it was due to the expertise of Apollo Doctors that the surgery went so well. I feel so good that I can go back to my work; though not even a month has passed for the surgery” said the patient.