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6 November 2020

Aortic surgery team save life of 77-year-old grandmother in first of its kind heart operation in north of England


Interventional radiologists and surgeons from Sheffield Teaching Hospitals NHS Foundation Trust have become the first NHS Trust in the north of England, and one of only a few centres in the world, to perform a minimally invasive procedure to repair a rare, life-threatening aortic arch aneurysm.

The complex surgery, performed by a skilled team of interventional radiologists, cardiologists, cardiothoracic and vascular surgeons at the Northern General Hospital, involved placing an expandable stent graft into the intricate structures of the aortic arch without the need for major open heart surgery.

Once in position the endovascular stent graft (a specially made fabric tube device framed with stainless steel self-expanding stents) seals the area where the potentially fatal aneurysm could burst, allowing the blood to pass through safely.

The cutting-edge procedure, which was managed safely in the middle of the coronavirus pandemic, has saved the life of Judith Savage, a 77-year-old grandmother from Barnsley.

“I would have had no idea that I was ill,” said Judith, whose age and poor levels of fitness meant she would not have been able to withstand conventional open heart surgery. “I went to the GP as I lost my voice and had a bad cough. The antibiotics cleared my cough but my voice didn’t come back.”

An x-ray revealed that something was not working around her vocal cords and the potentially fatal aneurysm, which can cause uncontrolled internal bleeding within seconds of bursting, was diagnosed through a CT scan.

Since the operation Judith has been recovering well, and can even go to the local shops.

“I would have died if I hadn’t had this procedure. The doctors, nurses and hospital have been fantastic.”

Aneurysms along the aortic arch are very rare and incredibly complex to treat. This is because the aortic arch is part of the aorta, the largest blood vessel where multiple vessels converge in ascending and descending formations to supply oxygen-rich blood from the heart to the brain, neck and arms.

Using x-rays and image-guided surgery, the stent graft is carefully placed into the aneurysm. As well as accurately positioning the stent graft with millimetre-precision, the team had to ensure the blood supply from the aortic arch continued to reach the head, neck and upper body while simultaneously using a pacing machine to rapidly pace the heart to maintain low pressure in the blood so that the stent did not get pushed out of the way.

Dr Mark Regi, Consultant Interventional Radiologist at Sheffield Teaching Hospitals NHS Foundation Trust, said: “This was a real team effort that wouldn’t have been possible without every member of the team, and is especially significant given we were able to perform this ground breaking operation during the recent coronavirus pandemic

Dr Stephen Goode, Consultant Interventional Radiologist, Sheffield Teaching Hospitals NHS Foundation Trust said: “Even within normal circumstances, an endovascular approach to repair an aortic arch aneurysm is technically very challenging. This is an excellent example of how clinicians in Sheffield are continuing to push the boundaries of medical and surgical practice, and the fact that we were able to safely care for and treat Judith who had limited options is an exceptional accomplishment and a testament to how a whole team approach can innovatively extend the frontiers of cardiovascular surgery even during these unprecedented times.”

The standard approach is to perform open surgery with the chest open and the patient placed on heart and lung bypass. This is known to have good long term results if the patient is fit enough to survive the surgery.

ENDS

Photos (clockwise from top left): Dr Goode and Dr Regi with the CT of Judith’s repaired aneurysm, Judith Savage, The South Yorkshire Cardiothoracic Centre, Chesterman Wing, Northern General Hospital, Sheffield where the groundbreaking procedure was performed, and the RelayBranch stent graft treating an aortic arch aneurysm



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