Doctors perform rare heart surgery on 71-year-old man with enlarged artery

A 71-year-old man from Odisha underwent a rare heart procedure which involved recreating the patient’s aortic valve.

Doctors at PSRI Hospital in New Delhi conducted complicated valve replacement surgery after the patient was admitted because he had an abnormally dilated major artery, putting him at an imminent risk of rupture.

Upon examination, it was found that the patient suffered from chest pain and shortness of breath, indicating a severe cardiovascular condition. It was then found that the major artery responsible for supplying blood to the heart was enlarged to 5.7 cm compared to the usual diameter of 2.5 cm.

This massive dilation along with a visible tear on the valve indicated a mortality risk of 50 per cent in 24 hours, if left untreated.
Addressing this complex problem called for the need to correct the aortic valve along with the aorta. The medical team, led by Dr.

Rahul Chandola, Cardiothoracic Surgeon at PSRI Hospital recognised the need to reconstruct the entire aortic valve (valve repair/ reimplantation) along with aortic reconstruction.

Traditionally, valve replacement involves implanting either a metal valve or an animal valve.

However, both these options come with inherent risks of thromboembolism (blood clot) and valve distinction (degeneration).

What is the valve replacement procedure?

A technique called Valve Sparing Root Replacement (also called David’s reimplantation Procedure, to pay tribute to the surgeon who initially conceived the operation, Dr Tirone David), was performed by Dr. Rahul Chandola.

During the operation, the patient is placed on a heart-lung machine (cardiopulmonary bypass), which takes over the function of the heart and lungs.

This complex procedure eliminates the need for foreign materials by first refashioning the patient’s native aortic valve and then reimplanting it inside the dacron graft (synthetic polyester graft stitched in the aorta of the heart).

Lead surgeon Dr Rahul Chandola said, “The patients who undergo valve reimplantation experience a significantly improved quality of life without the need for blood thinners, minimising the chances of valve-related issues in the future.”

Using the native valve helps patients avoid the need for anticoagulant medication for the rest of their lives, which is important for patients under conventional operations.

The traditional Bentall method that employs metal valves carries the risk of embolic episodes like stroke, along with the risk of fatal bleeding due to the need to take blood thinners.

“The surgery, which lasted around six and a half hours, required substantial backend work that took a total of 12 hours in all. Besides, it required a dedicated team of 11 to 12 medical professionals,” Dr Chandola added.