Four patients have successfully undergone surgery for the repair of Type A aortic dissection at Amrita Institute of Medical Sciences within a span of just 10 days, after they were referred post-haste from hospitals all over Kerala, including Palakkad, Perinthalmanna and Kochi, to save their lives.
An aortic dissection is a tear in the inner lining of the aorta (the largest artery in the human body which arises from the heart and from which all other blood vessels arise). The tear in the aorta wall occurs just above the aortic valve which separates the heart from the aorta. Blood enters inner layers of the wall of aorta through the tear, and passes downwards, sometimes all the way to the legs. Death occurs due to the rupture of the aortic wall because of pressure of the blood, or extension of the tear backwards to the aortic valve, causing a leak. Sometimes, the tear can extend to vessels supplying blood to the brain, triggering a brain stroke.
‘Type A’ Aortic dissection is a life-threatening medical emergency – without cardiac surgery, patient mortality is almost 100% within a few days. The condition is not very common and many patients die even before reaching the hospital. Very few hospitals in Kerala, or even in India, have the capability to conduct such surgery, and four such surgeries in a span of ten days is almost unheard of. One of the reasons for such success is that Amrita Hospital has established a dedicated Centre for Aortic Diseases and Marfan Syndrome - to cater to patients with all kinds of aortic diseases.
Said Dr. Kirun Gopal, Associate Professor, Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Kochi: “Type A Aortic dissection has a high mortality if not treated surgically, with half the patients dying within 48 hours of the tear occurring in the aorta. It is a rare disease with incidence of around 3.5 persons per 100,000 population. Due to this, diagnosis is usually delayed at hospitals that do not commonly see such cases. They treat the condition as a heart attack or problems arising due to acidity or gas. The most common symptom of Type A Aortic dissection is severe chest pain, which the patients typically describe as the worst-ever pain they have ever experienced in their life. Diagnosis is by echocardiogram or, more definitively, with CT scan of the chest.”
Added Dr. Praveen Varma, Professor and Head, Cardiovascular and Thoracic Surgery, Amrita Institute of Medical Sciences, Kochi: “The only effective treatment for type A aortic dissection is surgery. However, it is a major operation which involves replacing the aortic valve, the aortic root and the ascending aorta and re-implanting the coronary arteries into the graft. The surgery is done using a technique called total circulatory arrest. This involves cooling the patient to 18 degrees and shutting off the circulation completely for a short period, including the heart bypass machine, so that the aorta can be repaired. The operative mortality is higher compared to standard cardiac surgery, varying from 17-26%.The patients need to be operated as soon as they arrive at the hospital, as mortality increases with each passing hour. At Amrita Hospital, we have experience of patients having a cardiac arrest in the casualty or even while being shifted to the operating theatres.”
He added: “The surgery for Type A aortic dissection typically takes around six hours. Last year, we at Amrita Hospital conducted five cases of acute aortic dissection with no mortality at all. These past 10 days, however, we have done four cases successfully. This is a big achievement as this surgery is not done in most cardiac surgery centres due to the higher risk of patient dying. It is a ten hour surgery that costs about Rs 4 to 5 lakhs.”
The four patients which successfully underwent surgery for repair of Type A aortic dissection include Jayanthi, a 43-year-old housewife from Wayanad, and Subramaniom Potty, a 59-year-old retired temple Santhi from Kochi. Both these patients were operated by the surgical team one after the other without a break. The other two patients include John S, a 55-year-old ex-army man, and Krishnaveni, a 59-year-old retired teacher.