The Department of Cardiothoracic and Vascular Surgery (CTVS) at All India Institute of Medical Sciences (AIIMS) Jodhpur successfully performed a highly complex and life-saving emergency surgery on a female patient suffering from acute aortic dissection along with morbid obesity and multiple serious comorbidities.

Dr. Surendra Patel, Additional Professor, stated that the 57-year-old female patient weighed 122 kg and was suffering from morbid obesity, diabetes, hypertension, and obstructive sleep apnea requiring nightly BiPAP support. She had been experiencing chest pain and breathing difficulty for the past two months. After initial treatment at hospitals in Sri Ganganagar and Bikaner, she was referred to AIIMS Jodhpur considering the complexity and high-risk nature of her condition.

At AIIMS Jodhpur, Dr. Pawan Garg from the Department of Radiology diagnosed the patient with acute aortic dissection on CT scan evaluation. This is a life-threatening condition requiring immediate surgical intervention. During the surgery, ascending aorta and hemiarch replacement were performed using a Dacron graft. The procedure also involved the use of the circulatory arrest technique, during which blood circulation to the entire body except the brain is temporarily stopped. In this technique, the patient’s body temperature is reduced to nearly 20–24°C to protect vital organs. The patient’s aortic valve was successfully repaired and preserved instead of being replaced.

Doctors explained that aortic dissection surgery itself is considered one of the highest-risk cardiac emergency procedures and carries very high morbidity and mortality rates. The surgery in this patient was particularly challenging because of severe obesity and associated comorbidities including obstructive sleep apnea. Special side-arm supports had to be arranged on the operating table as the patient could not fit on a standard operating table. The patient also had a short neck, making airway management and endotracheal intubation extremely difficult during anesthesia administration.

The complex operation was led by Dr. Surendra Patel and assisted by Dr. Alok Kumar Sharma, Dr. Anirudh Mathur, and resident doctors Dr. Bajrang and Dr. Vikram. From the Department of Anaesthesia, Dr. Rakesh Kumar, Dr. Manoj Kamal, and Dr. Gurusaran played crucial roles in perioperative management and critical care support. Cardiologist Dr. Atul Kaushik confirmed the diagnosis through echocardiography and ensured that the aortic valve could be safely preserved.

The anesthesia and critical care management played a vital role in the successful outcome of this high-risk surgery. Due to morbid obesity and obstructive sleep apnea, securing the airway and ventilatory management were extremely challenging. Although the patient was extubated on postoperative day one, she required continuous non-invasive respiratory support and prolonged BiPAP therapy for nearly two weeks. The anesthesia and critical care team led by Dr. Manoj Kamal ensured meticulous postoperative management, which significantly contributed to the patient’s successful recovery.

The department also acknowledged the contribution of all resident doctors of the CTVS department, perfusionist Mr. Kamlesh, and the nursing officers of the CTVS Operation Theatre and CTVS ICU in the successful management of this critically ill patient.

Postoperatively, obesity-related elevation of the diaphragm caused severe respiratory difficulty, requiring prolonged oxygen therapy and intensive respiratory support. As expected in such high-risk cases, the patient required prolonged ICU care and remained admitted for nearly 20 days. Despite these challenges, the patient recovered successfully and was discharged without the need for oxygen support.

Dr. Alok Kumar Sharma, Additional Professor and Head of the Department of CTVS, stated that the department has now successfully performed 10 major aortic surgeries including complex hemiarch repairs with encouraging outcomes. He added that this particular case was especially challenging because of the patient’s severe obesity and multiple comorbidities, and was managed successfully through coordinated multidisciplinary teamwork involving cardiac surgeons, anesthesiologists, intensivists, cardiologists, radiologists, perfusionists, and nursing staff.

Prof. Dr. G. D. Puri, Executive Director, AIIMS Jodhpur, congratulated the entire CTVS team for the successful management of this high-risk patient and appreciated the department’s growing expertise in advanced cardiac and aortic surgeries.

What is Aortic Dissection?

Aortic dissection is a life-threatening condition in which a tear develops in the inner wall of the aorta, the body’s main artery. Blood enters through this tear and separates the layers of the aortic wall, which can result in rupture of the aorta, severe internal bleeding, inadequate blood supply to the brain and other organs, organ failure, or sudden death.

Common symptoms include:
• Sudden severe chest, back, or abdominal pain
• Breathlessness
• Fainting or extreme weakness
• High blood pressure
• Stroke/paralysis
• Sudden decrease or stoppage of urine output

Experts advised the public to seek immediate medical attention in case of sudden severe chest or back pain, as timely diagnosis and emergency surgery can save lives.

Obesity Control and Heart Health Awareness

Experts highlighted that obesity significantly increases the risk of hypertension, diabetes, heart disease, and aortic disorders. Maintaining a healthy lifestyle can reduce the risk of these major cardiovascular emergencies.

Healthy lifestyle measures include:
• Maintaining a healthy body weight
• Exercising regularly
• Eating a balanced diet low in excess oil, salt, and sugar
• Regular monitoring of blood pressure and blood sugar
• Avoiding tobacco and limiting alcohol consumption

 

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