May 9, 2014
CALGARY — For the first time in Alberta, local cardiac specialists are now able to repair bulges in the upper aorta of the heart using a minimally invasive procedure that reduces hospital stays, speeds recovery and improves outcomes for patients.
So far, one Alberta patient has undergone endovascular total arch reconstruction at the Libin Cardiovascular Institute of Alberta – an entity of both Alberta Health Services (AHS) and University of Calgary.
The procedure treats aortic aneurysms, a weakening in the wall of the main artery that supplies oxygen-rich blood to the rest of the body, causing the artery to bulge like a balloon. The potentially fatal condition generally requires open-heart surgery when aneurysms occur in the upper aorta, where the vessel branches off to direct blood to the brain.
“Many patients are old or frail, which makes open-heart surgery very risky. This new procedure is done without dividing the sternum bone and spreading the ribs and is therefore less invasive and offers patients a better chance of recovery,” says AHS cardiac surgeon Dr. Jehangir Appoo. “It also shortens their hospital stay from a few weeks to just a few days.”
The procedure requires a multidisciplinary team that includes specialists from cardiac surgery, interventional radiology, cardiovascular nursing and cardiac anaesthesia.
Dr. Appoo, Dr. Jason Wong and Dr. Eric Herget from interventional radiology use a specialized stent graft, or tube, custom built to match a patient’s anatomy and branches in their aorta.
Making incisions on either side of the neck and at the groin, pieces of the stent are guided by
X-ray and carefully moved through the arteries towards the heart, where they meet at the branch in the aorta where the aneurysm occurred, reinforcing the aorta’s wall. The entire procedure takes about six hours and has been attempted about 40 times worldwide.
“This is tremendous news for patients. This minimally invasive procedure means we can reinforce the wall of the aorta without having to open their chest and perform invasive surgery,” Dr. Appoo says. “At the end of the day, for a select group of patients, it’s a much safer operation.”
Aneurysms that occur in the descending aorta, which runs through the abdomen and feeds the lower half of the body with oxygenated blood, are usually treated with a similar procedure, where a stent graft is inserted through the groin and maneuvered up towards the heart.
Doug Sinclair underwent the procedure last summer to repair aneurysms in his upper aorta as well as his descending aorta, which would have required a second open-heart operation.
Instead he underwent endovascular total arch reconstruction. He was awake and talking immediately after the operation and was home in a few days. He says he was able to return to work as a photographer in September.
“After the procedure, I felt better right away. I had the operation on a Wednesday and was back home on Monday,” the 66-year-old says. “Before, I couldn’t lift anything more than 10 pounds. Now I walk on the treadmill five days a week.”
Physicians continue to monitor his recovery.
Dr. Imtiaz Ali, Chief of Cardiac Surgery with Libin Cardiovascular Institute of Alberta, says endovascular total arch reconstruction has opened a new chapter in cardiac surgery in Alberta.
“In the past, many patients were forced to live with this condition because they were unable to undergo invasive surgery to correct their aortic aneurysms,” he says.
“This year, Libin Cardiovascular Institute is celebrating 10 years of saving lives through research and innovative care. This leading edge procedure is one more example of how we are transforming cardiac care in Alberta and around the world.”
The Libin Cardiovascular Institute of Alberta coordinates cardiovascular science research, education and patient care as an entity of both Alberta Health Services (Calgary) and the University of Calgary. It provides education and training of health care professionals and offers world-class treatment using new technologies and access to cardiac services. The Institute is committed to developing outstanding cardiovascular health promotion and disease prevention programs by translating innovative research into novel health-care solutions. Learn more at www.Libin10.ca
Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.
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