Innovative surgical method gives Sylvia Neikes a new lease on life

“We should be able to manage that by 10 a.m. tomorrow, right?” Sylvia Neikes looks expectantly at her attending physician, Dr. Mohammed Morjan. He nods in agreement. The 70-year-old is planning her discharge from the hospital. She is happy that she can now go home. She will soon be transferring to a rehabilitation clinic to recharge her batteries. The past few months have been exhausting. Her life has on the line several times.

Since last autumn, Sylvia Neikes has had to undergo two life-threatening operations. At the beginning of October, vascular surgeons at Düsseldorf University Hospital (UKD) performed emergency surgery to repair a tear in her descending aorta using a small mesh tube (medically known as a stent), thereby saving her life. In mid-February, surgery on her aortic arch became necessary. The artery had expanded significantly in this area and was at risk of rupturing again. This time, the aortic team from the cardiac surgery department took over the treatment and, for the first time in North Rhine-Westphalia, used a gentler, innovative procedure.

The aortic arch is the part of the aorta that leads directly away from the heart. This area contains vital branches that supply the brain and arms with oxygen-rich blood. In Sylvia Neikes' case, this sensitive area had to be replaced with a vascular prosthesis due to the alarming dilation of the vessel.

Challenging surgery on the aortic arch with circulatory arrest

Cardiac surgery on the aortic arch is very challenging. Although a heart-lung machine is used, the patient's circulation is usually completely shut down for about 40 minutes to prevent blood from flowing through the vessel being operated on. At the same time, the body must be cooled to 26 degrees to prevent brain damage. Within the available time window, the vascular prosthesis must be inserted and sutured at all entry and exit points.

In Sylvia Neikes' case, heart surgeon Dr. Mohammed Morjan, head of aortic surgery at the Clinic for Cardiac Surgery, opted for a new hybrid procedure that reduces the risk of circulatory shutdown to half the time. This procedure combines classic cardiac surgery techniques, a slightly modified aortic arch prosthesis, and vascular access via a thin tube (catheter) to insert stents from the inside. Instead of laboriously suturing the branches of the artery to the brain and arms, a stent connects the newly implanted vascular prosthesis to the outgoing arteries.

Confidence that the new procedure will become established

"With this new procedure, which was first implemented and applied in cooperation with the cardiac surgery department at Ludwig Maximilian University in Munich, we can now also provide fragile patients with aortic arch replacement surgery," says Dr. Morjan. In the case of Sylvia Neikes, the treatment team at the UKD's interdisciplinary aortic centre, which involves vascular and cardiac surgery, opted for the innovative, gentler treatment approach – particularly given her pre-existing heart conditions and the emergency surgery she had already undergone. ‘The shorter the operation and the time the circulation is shut down, the more we reduce the risk of surgery, for example, with regard to possible strokes,’ explains Dr. Morjan. However, he also emphasises that the new procedure is not yet in regular use. Depending on the individual case, it is used in the context of so-called ‘individual healing attempts’ in renowned aortic centres such as the UKD. Dr. Morjan is confident that the procedure will ultimately become established.

Sylvia Neikes is also optimistic. Her final examinations have all been positive. “Over the past few months, I have been in a state of limbo. Now I am looking forward to spring and can look ahead.” Soon she will be able to go for walks with her dog again.

Text/Photo ©UKD