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CASE STUDY: Collaboration for aortic dissection repair

A patient experienced an acute aortic dissection. Emergency open-heart surgery at his regional medical facility did not solve the issue; days after the open-heart procedure, the patient was still nauseated and his blood pressure was spiking. The patient was transported by helicopter to the dedicated USC Comprehensive Aortic Center at Keck Medicine of USC.

Cardiac surgeon Fernando Fleischman, MD, discovered that the patient had been left with a residual dissection that had ballooned, with an extremely high risk of rupture, stroke, and death. Upon starting the procedure to repair the dissection, Fleischman discovered that extended to several other major arteries. He worked for eight hours, including performing a “frozen elephant trunk” procedure to give a more durable repair to the patient’s aortic arch. Fleischman used an innovative hybrid of open surgery and minimally invasive techniques to extend the repair and stent the arteries stemming from the aortic arch. He also completely rebuilt the subclavian artery. Fleischman knew that his procedure might have compromised an artery to the patient’s hindbrain, putting him at risk for a stroke, so he called in vascular surgeon Sukgu Han, MD.

Fleischman handed directly off to Han, who performed a vertebral artery bypass as well as a bypass of the left carotid to subclavian artery. By the end of the two procedures, Fleischman and Han had completely rebuilt all the major parts of the patient’s circulatory system that led to his brain and arms.

The patient was stable after the operation, but wasn’t acting himself and was experiencing hallucinations. The team soon discovered the cause: A dissection of the carotid artery was reducing blood flow to the patient’s brain.

Han reconstructed the patient’s left common and internal carotid arteries using a hybrid approach similar to the arch reconstruction. This final operation was just seven days after the double procedure at Keck Medicine and seventeen days after his emergency open-heart procedure at his regional hospital.

More than a year later, the patient is doing well, an active walker and golfer who does daily hour-plus cardiovascular workouts. Both Fleischman and Han credit close collaboration as well as the patient’s active participation in his own recovery for the positive result.