Complex Case Successfully Handled by Hoan Cuu My Long Hospital Using Hybrid Interventions17/03/2021
HOAN MY CUU LONG HOSPITAL SUCCESSFULLY TREATED A COMPLEX CASE WITH HYBRID INTERVENTIONS. Hybrid surgery is a method that combines several cardiovascular surgeries at the same time, and can be applied to complicated heart diseases. On 17 March, Hoan My Cuu Long Hospital successfully applied this method to treat a patient with severe aortic dissection in an operation lasting more than 9 hours. The patient was Mr. N.C.T (born 1967, living in Hong Dan, Bac Lieu). One day before hospitalisation, the patient suddenly felt epigastric pain and chest pain. The pain intensity did not improve, so the patient was admitted to Hoan My Cuu Long Hospital on 15 March. By examination and CT scan of the aorta in the chest, abdomen and pelvis, he was found to have an aortic dissection from aortic root to iliac arteries on both sides. Combined with echocardiography, he was found to have acute heart failure, severe aortic regurgitation and a tear in the intimal lining of the aorta in the coronary sinus area. He was diagnosed with aortic dissection in the chest, abdomen and pelvis on both sides, and severe aortic regurgitation. Tran Phuoc Hoa, M.D., MSc., PhD., Head of the Cardiology Department, Hoan My Cuu Long General Hospital, said that the aorta wall is composed of three layers with different histological properties. Aortic dissection is a condition in which the inner layer of the aorta tears and blood surges through the tear, causing the inner and middle layers of the aorta to separate, leading to consequences such as hemorrhagic shock after rupture of an aortic dissection, and anemia in other organs due to the plaque rupture, to fill the natural openings of the vascular arteries in the body.
In response to this life-threatening emergency, the Board of Directors of Hoan My Cuu Long Hospital conducted a level-3 consultation with relevant departments to agree on a treatment plan that combined surgical aortic valve replacement, ascending aorta replacement, aortic arch repair and endovascular stent graft placement for the patient. At 5:00 pm on 16 March, the patient was transferred to the operating room. The patient was anesthetised, provided with ECMO, had heart failure, underwent surgical aortic valve replacement and ascending aorta replacement, and underwent a coronary artery bypass graft of two coronary arteries. He had hypothermia below 25 degrees, circulatory arrest, selective cerebral protection and endovascular stent graft placement. ECMO was re-established to feed organs and the brain, and activate the heart to work again. The surgery ended at 2:00 am on 17 March, lasting nearly 9 hours. The patient was transferred to the recovery room after heart surgery for further monitoring. The patient is in a good condition and is recovering. Hybrid surgery applies to patients with severe and complex lesions that are difficult or cannot be handled with simple surgical or medical measures. For patients with complicated vascular diseases, elderly patients and patients with multicentric lesions, the application of classic methods such as simple surgeries or simple medical interventions will not be effective because they cannot be performed at multiple locations at the same time. Hybrid interventions allow doctors to thoroughly treat lesions in one go, leveraging the advantages of surgeries and intravascular intervention, and reducing the negative impact on the patient’s health. This technique brings advantages both in treatment outcomes as well as in economic benefits for patients, and has been globally applied in the treatment of cardiovascular diseases for many years. However, this is a highly advanced technique that has not yet been widely applied. According to Dr. Hoa, this technique requires not only modern medical equipment but also experience, professional skills and proper coordination of surgical teams. The Cardiology Department is one of the key specialist departments of Hoan My Cuu Long Hospital. With a sizable investment in medical equipment, skills development for doctors, cooperation with and learning from leading experts, the Department has made strides in the screening and treatment of heart diseases, especially congenital heart disease and complex cardiovascular diseases, contributing to the development of medical services in the Mekong Delta.