Our team completes UK-first heart procedure

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Our cardiology team has performed a pioneering minimally invasive procedure to treat disease of the heart’s largest arteries, avoiding the need for open-heart surgery.

A silent condition which can be deadly

The aorta is the largest artery and carries blood from the heart to the rest of the body. Sometimes, the ‘arch’ of this artery can become diseased, forming a balloon-like bulge – called an aortic arch aneurysm. It develops slowly without symptoms but can rupture if the aneurysm becomes particularly large. This rupture can be life-threatening and require emergency intervention, with chances of survival as low as 50% and patients aged 50-65 most at risk.

Lifestyle and medical treatments are the first line of therapy for an aortic arch aneurysm, but an elective surgery may be recommended to prevent a rupture. Typically, this involves an open-heart procedure to replace all or part of the arch of the aorta, which is associated with a long hospital stay. Although risks during this elective surgery are low and can greatly improve the 5-year survival of a patient (a measure of success for a surgical procedure), it may not be suitable for high risk patients, such as those that are elderly.

A new approach with keyhole surgery

A 78-year-old patient was recently referred to our centre for an elective surgery to repair her aortic arch aneurysm. However, as she was in too frail a condition to perform a standard open-heart surgery, the cardiology team at Royal Brompton Hospital trialled a new type of keyhole surgery to treat her heart.

The team, led by consultant interventional cardiologist Professor Christoph Nienaber and consultant cardiac surgeon Mr Ulrich Rosendahl, operated on the patient’s heart in the hospital’s state-of-the-art hybrid operating theatre – a traditional operating theatre but with advanced imaging capabilities to help perform keyhole surgery on the heart.

In the first stage of the surgery, consultant vascular surgeon Mr Maziar Mireskandari performed a ‘crossover bypass’ surgery, which is a procedure used to maintain blood flow to the patient’s brain and prevent a stroke – one of the main problems associated with keyhole surgery for the aorta.

In the second stage, two custom-sized Nexus™ stents were placed inside the diseased arch of the aorta using keyhole surgery. Stents are small tubes made of a metal mesh that replace the function of the diseased blood vessel from the inside, allowing the blood to flow normally through it. The Nexus stents were custom prepared for the patient and put in place by guiding them from the patient’s groin artery up to her heart using medical imaging and were fitted together from inside the artery.

Due to the minimally invasive nature of the procedure, the patient was able to leave her bed very quickly and was discharged within a few days, with her recovery time reduced from several weeks.

Successful UK-first

Our team were the first to use this type of stent on a patient in the UK, and the first to treat an aneurysm encompassing the entire arch of the aorta by combining a crossover bypass surgery with a keyhole surgery.

Professor Nienaber said: “We’re delighted that this combined procedure went so well and achieved such a terrific result for our patient. It took careful planning and was made possible through a highly skilled, multidisciplinary team, involving surgeons, anaesthetists, radiologists and cardiologists and lots of supportive team spirit.

“We’re proud to be the first in the UK to complete this pioneering procedure and look forward to establishing this innovative technique at the Trust so more patients can benefit.”

The NexusTM Stent Graft System (centre) transforms a complex open-heart surgery to repair an aortic arch aneurysm (left) into a standard keyhole procedure. The multi-part stent is customised to fit each individual patient optimally and is the first branched stent system to treat disease of the aortic arch. A 3D CT scan (right) shows the stent placed in the patient’s aortic arch.