Pathology:
The Aorta is the main blood vessel (Artery) that carries blood from the heart to the rest of the body. The wall of the Aorta is made of 3 layers. Whenever there is an injury to inner most layer of Aorta, blood is forced between the layers of the Aortic wall tearing the layers apart. This condition is referred to as Aortic Dissection. In most cases, Aortic Dissection is associated with sudden onset chest pain or back ache often described as tearing in character.
Complications:
Tearing of the layers can progress rapidly due to blood flowing at high pressure resulting in life threatening complications such as
- Cut-off of blood flow to heart leading to Heart Attack or to brain leading to Stroke;
- Dissection extending into the Aortic Valve causing sudden onset leakage;
- Rupture & Cardiac Tamponade leading to sudden death;
- Failure of organs such as Kidney & Liver.
Due to the rapidity with which Aortic Dissection progresses, 20% of the patients die before reaching the hospital. If not treated urgently, the death rate is as high as 1-3% every hour from onset in the first 24 hours.
Treatment:
The usual investigations needed to diagnose and plan treatment for Aortic Dissection are 2D Echo & CT Scan with Contrast (CT Aortogram). The procedure required to treat Aortic Dissection depends on the segment of Aorta involved.
- Open Aortic Surgery
- Replacement of damaged segment of Aorta with a Tube Graft in cases where the Aortic Valve is not damaged.
- Replacement of the damaged segment of Aorta & Aortic Valve known as Bentall Procedure.
- Replacement of damaged segment of Aorta & re-implantation of Aortic Valve known as David Procedure.
- Endovascular Repair such as “Thoracic Endovascular Aortic Repair (TEVAR)”
This procedure is performed in a Cathlab under fluoroscopic guidance. A covered stent (Metal Mesh Tube interwoven with a fabric) is placed such that both ends rest within the healthy segment of the Aorta, while the middle section of this stent provides a route for blood to flow, thereby excluding the dissected segment of the Aorta.
- Hybrid Procedures such as “Complex Aortic Arch Replacement with Frozen Elephant Trunk Procedure (FET)”
This procedure is a combination of both Open Surgery and Endovascular Repair. A Thoraflex Hybrid Prosthesis is surgically implanted to achieve complete correction of the Aortic Arch Dissection along with Descending Thoracic Aortic Dissection.
Dr. Dhairyasheel Kanase is one of the leading cardiac surgeon in India having performed many complex Aortic Dissection Surgeries with excellent outcomes. He is also the 1st Cardiac Surgeon in Western India to successfully perform Complex Aortic Arch Replacement with Frozen Elephant Trunk using Thoraflex Hybrid Prosthesis.
