For first time, doctors replace an entire aorta

June 11, 1993|By Richard Saltus | Richard Saltus,Boston Globe

BOSTON -- In a complex and daring operation, surgeons at the Lahey Clinic in Burlington, Mass., have for the first time replaced a patient's entire aorta -- the largest and most crucial blood vessel in the body -- in a single procedure.

Until now, surgeons had considered it too risky to replace the delicate aorta all at once. As a result, patients with diseased aortas had to undergo two or more separate surgeries weeks or months apart as surgeons replaced the diseased vessel in sections.

The 67-year-old patient, who requested anonymity, underwent the operation four weeks ago to replace a dangerously enlarged aorta, and was reported yesterday to be doing well.

"It is quite an intrepid thing to do," commented Dr. Denton Cooley, the pioneering Houston cardiovascular surgeon. "It is a massive procedure, and this is a real tour-de-force."

Dr. Cooley, who performed the first repairs of enlarged aortas in the early 1950s, said modern techniques have "given us the ability to do things we never dreamed of six or eight years ago."

Dr. Lars Svensson, who headed the Lahey surgical team, said the enlargement of the man's aorta along its entire length was so dangerous and painful that he probably would have died without an immediate one-step replacement.

Dr. Svensson said he used 36 inches of Dacron tubing to replace the man's diseased aorta.

"He was in severe pain, and he could no longer eat because the aneurysm was blocking his esophagus," said Dr. Svensson in an interview. Normally about 2 1/2 or 3 centimeters in diameter, the aorta in the sick man had enlarged over its entire length and had widened to as much as 5 1/2 inches. "It is amazing that it hadn't ruptured," added the surgeon.

The aorta, normally about the diameter of a garden hose, is the main conduit of blood pumped by the heart to all the organs. Sometimes, as a result of aging processes, high blood pressure, a connective tissue disease called Marfan syndrome or other factors that weaken the vessel's wall, the aorta balloons out in one small area or over much of its length.

Aneurysms, as such widenings are called, often burst and frequently are fatal. Country music star Conway Twitty died last week from a ruptured aortic aneurysm.

Dr. Svensson said his patient's aortic enlargement probably was caused by an autoimmune disease known as giant cell arteritis.

Dr. Svensson, who trained with the late cardiovascular surgeon Dr. E. Stanley Crawford at Baylor College of Medicine in Houston, said the risky operation succeeded in part because doctors cooled the man's body to about 65 degrees Fahrenheit to put the brain and other vital organs into a state of virtual hibernation.

At that temperature, an individual can survive without oxygen for an hour or more, and the cooling enabled the surgeons to stop the heart and drain the body of blood.

As an additional measure to protect the brain, Dr. Svensson inserted a tube into the jugular vein in the neck so that blood could be pumped into the brain while the heart was stopped.

Then, working first through the chest incision, Dr. Svensson replaced the upper, ascending section of the aorta while the heart lay stilled for half an hour. He then restarted the heart and replaced the descending portion of the aorta.

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