Abu Dhabi Doctors Devise Innovative Method to Reduce Significant Risk of Aortic Aneurysm Surgery

In a global first, the modified branch-first technique eliminated the need for cardiopulmonary bypass and circulatory arrest, reducing risk of mortality

Doctors at Cleveland Clinic Abu Dhabi, an integral part of Mubadala Health, have developed a new technique that can greatly reduce the risk involved in aortic aneurysm surgery. The modified branch-first surgical technique was performed for the first time on a patient undergoing open surgical repair of his enlarged aorta at the hospital. 

Abu Dhabi-resident Moussa Abd - ElRaihim Elgohary was transferred to Cleveland Clinic Abu Dhabi with a 6.5cm thoracoabdominal aortic aneurysm (TAAA), which is the ballooning of the aorta – the main artery in the body that arises from the heart and supplies blood to the rest of the body – in June 2020. This was caused due to the gradual weakening of the artery after a lifestyle-related aortic dissection, a serious condition that causes the inner layer of the artery to tear, which he had suffered a few years ago.  

A minimally invasive endovascular aneurysm repair procedure to treat this condition was not a feasible option on the 52-year-old patient because his aorta had coiled up in the abdomen, where it would not be possible to place a stent graft to support the aneurysm. 

The only treatment option to prevent a rupture was an extensive open surgical repair, which is considered the gold standard. Very few hospitals around the world are equipped to offer this treatment because of its complexity, and high mortality and morbidity rate. 

Traditionally, it requires placing the patient on a heart-lung machine (cardiopulmonary bypass) and stopping the circulation of blood to organs for 18 to 30 minutes, making it crucial to remove the diseased part of the aorta and replace it with a tube-shaped woven fabric graft within a short span of time. The surgery, which can take up to 12 hours, increases the risk of bleeding by 20 percent, along with increasing the chances of mortality and organ dysfunction by 15 percent. Patients may also need up to 20 units of blood and blood products transfused during the operation. 

But in a global first, surgeons in the Heart and Vascular Institute at Cleveland Clinic Abu Dhabi performed a modified branch-first surgery that eliminated the need for a cardiopulmonary bypass and circulatory arrest, significantly reducing the risk to the patient’s life. This new technique has been published in the Journal of Thoracic and Cardiovascular Surgery.

Dr. Niranjan Hiremath, an associate staff physician in cardiac surgery in the Heart and Vascular Institute at Cleveland Clinic Abu Dhabi, who was part of the team that treated the patient, says he trained in a similar branch-first technique in Australia, which uses a heart-lung machine during the operation. 

“We wanted to further modify this technique to reduce the risks associated with the use of a heart-lung machine. What we did differently is that we plugged in a tube to the upper, non-diseased part of the aorta and started circulating the patient’s own blood into the organs before we even began the main aortic repair. So, instead of drawing blood from the patient and putting it through a heart-lung machine and then back into the patient’s body, the blood kept circulating through the graft that was attached to the organs.” 

This, he says, caused minimal bleeding and the operating team did not have to rush through the surgery since the abdominal organs received blood supply without interruption. They did not have to give the patient additional units of blood either. As a result, the team managed to complete the operation successfully within eight hours. 

Dr. Woosup Michael Park, the department chair of vascular surgery in the Heart and Vascular Institute at Cleveland Clinic Abu Dhabi, says that the team put their minds together and collaborated for the best solution for the patient and physicians treating him.

“These patients are traditionally referred for such surgeries outside the country but with this innovation, we feel very comfortable offering the full range of treatments for TAAA right here, close to home.”

This easy-to-replicate procedure, he adds, can have far-reaching benefits for surgeons around the world. 

“The whole point of this technique is that it does not require you to be fast and gives you a better result. At no point during the operation did we feel like we were hurried or stressed. The spirit in the operating room was in control as it was a collaborative effort between multidisciplinary teams at the hospital.” 

Moussa says that it took him less than a month to recover after surgery and now he is back to doing all his favorite activities. 

“When I started having dizzy spells, and chest and back pain in June, my daughter rushed me to another hospital, but they said that my case was too complex and that I needed to be transferred to Cleveland Clinic Abu Dhabi. I’m very grateful for being treated right here under the care of these talented doctors who made sure that there were no complications and I recovered fast,” he says.

“I’m now back to doing what I love the most, being outdoor, riding my motorbike, taking my boat out sailing, and jet skiing,” he added. 

For more information or to book an appointment at Cleveland Clinic Abu Dhabi, call 800 8 CCAD (2223) visit www.clevelandclinicabudhabi.ae or download the Cleveland Clinic Abu Dhabi app.