A team of surgeons at St. Charles Bend performed a novel surgery February 10 that saved the life of a 79-year-old patient who couldn’t tolerate a more conventional—but invasive—open-heart approach.
The patient came to the hospital experiencing chest pain as the result of a leak in his ascending aorta. Years before he had undergone surgical reconstruction of his proximal aorta, an open-heart surgery that takes hours to perform and many days from which to recover. But now the repair was starting to fail, putting his life at risk.
Because of his age and condition, the patient couldn’t safely tolerate another such surgery, which is the normal standard of care, said Dr. Wayne Nelson, a vascular surgeon at Oregon Vascular Specialists who led the team. Also participating was Dr. Jason Jundt (vascular surgery), Dr. Jen Dixon (cardiothoracic surgery), Dr. Bruce McLellan (cardiology) and Dr. Brian Tomkins (anesthesiology).
After researching a variety of stent grafts, Nelson found a new one—released merely weeks ago—that could work. Though not yet approved by the Food and Drug Administration (FDA) for use in the ascending aorta, the stent graft’s dimensions would almost perfectly reinforce the wall of the patient’s leaking aorta and help keep the damaged area from rupturing.
But even after finding the right stent graft, the team was presented with still another challenge: the patient’s leg arteries, through which most endovascular surgeries are performed, were too small and diseased to safely deliver the stent graft. Dr. Nelson decided to try and advance the endograft into position using an incision in the patient’s neck and going through the right carotid artery instead.
“We advanced the stent graft down his neck into the ascending aorta and deployed it where it should go,” he said. “It worked fantastic. He went home after two days.”
Nelson said this approach may be a viable option going forward in patients who have life-threatening conditions and no traditional surgical options.
“It’s an innovative approach to fix a problem in someone who won’t tolerate the normal surgical standard of care,” he said. “However, this is only a limited, single event that we can’t draw any conclusions from. But it worked very well.”