Arresting measures

When Numeriano Bayot, a 62-year-old Dubai-based ship captain was reeling with crippling chest pain, he thought he was having a heart attack. But doctors told his relatives that his condition was much more serious.

The Filipino expat's chest pains were the result of a split in the wall of the aortic arch, the main blood vessel above the heart. Only an unusual and complex surgery can repair this. Without the surgery, the patient will bleed to death as the whole vessel can explode. Statistics show that without an emergency operation, 50 per cent of such patients die within 24 hours.

"If you arrive at the hospital with an emergency like this patient, there is no choice but to operate immediately," says Professor Uwe Klima, chief of the Department of Cardiothoracic Surgery at the American Hospital in Dubai.

"The only option for that patient to survive is to have the surgery or face death."

With no intention of sounding overly dramatic, Professor Klima explains that the condition requires one of the most urgent operations in cardiac surgery.

Professor Klima had the task of making Bayot, his wife and son understand the seriousness of the condition. "I had to let them know that splits in the arteries could extend all the way down to his legs or go all the way up to his brain - and would, at some point. Then he would suffer a stroke and die."

It was the first time Bayot had ever been hospitalised, but he and his family made quick, informed decisions. "After that, it was a race against time to prepare the patient, repair the damage and ensure that he was in good shape after the traumatic procedure," says Professor Klima.

Before inducing circulatory arrest or turning off the flow of blood to the body and effectively stopping the heart, Bayot's body first had to be cooled to 28°C. This slams the brakes in the body and protects the brain. Ice packs are placed around the patient's head to cool the brain and his blood circulation is cut off completely so that the surgeons have a two-hour window to repair the damaged vital vessel, the aortic arch. The surgeons monitor the brain via a heart-lung bypass machine during the operation.

"The cooler the body is, the less oxygen is consumed, the less energy the body needs and the less damage is done to the body," explains Professor Klima, who performed the procedure in the UAE for the first time on Bayot. "This puts less stress on the patient and reduces the risk of complications."

The procedure was pioneered by Dr Hans Borst at Germany's Hannover Medical School where Professor Klima trained and was previously based. He then trained the American Hospital's Heart Centre team in the surgical procedure after arriving in Dubai last year.

It allows the surgeon to work in a quiet, bloodless field and improves the outcome. Once the aortic arch is repaired by inserting a prosthesis, another crucial phase begins as the patient's body is carefully rewarmed.

"Once you have repaired the aortic arch and connected it to the main aorta, the system is closed again. Like a plumbing system, all valves and all exits must be closed. We then do the reverse of what we did at the beginning of the procedure and pump the blood back into the body," says Professor Klima.

"If your blood is going through an artificial tubing system, pumps and so on, there is a lot of stress and a lot of trauma to the blood, so the shorter the rewarming period the better."

Bayot slept for three to four hours after the surgery. As soon as he woke up he could move his limbs. The doctors assured him he'd be fine. He was discharged within ten days and advised to keep his blood pressure under control and visit the doctor for regular check-ups.

"This was the first time I had been in hospital and I am now at home and living normally," says Bayot, who has lived with his family for 12 years in the UAE and is now visiting relatives in the Philippines. "Within 24 hours, I was able to move my limbs normally."

Professor Klima says patients have a much better chance at recovery after this operation now than years ago when temperatures were cooled much lower than the current 28°C. "Before this degree of temperate lowering, the patients often woke up and suffered a stroke. Also the more you cool the patient, the more chance of bleeding after surgery."

He lists other conditions that could necessitate this surgery. One is aneurysm, which exposes a weak section in the aortic system where the arteries widen or grow bigger over time. Another is a genetic condition called Marfan Syndrome where children come in with dilated, ruptured vessels. Food infections such as the deadly salmonella could also cause the wall of the aortic arch to balloon and grow thinner until such a point that it ruptures.

Professor Klima has performed more than 150 of these surgeries in Hannover. He says regular screenings help doctors to detect the condition much earlier.

"There isn't enough preventive screening in this region. Patients need to change their attitude to one of prevention rather than only visiting the doctor when they are sick.

"It's important to have regular check-ups so that you know whether you are healthy."

He says that people should be proactive in their health check-ups because if they wait until the problem explodes, it may be too late to fix it. And there are rarely second chances at taking care of yourself.