Multidisciplinary team saves patient’s life

5 Mar 2021

The 89-year-old patient initially sought medical attention due to a small gastric bleed. However, scans found a 9.5 centimetre aortic aneurysm in his abdomen, which was at high risk of rupture and death.

It was discovered that the patient also suffered from aortic stenosis, a narrowing of the aortic valve, and that surgery to treat the aneurysm was not possible without treating his heart condition as well.

As such, the patient was transferred to St John of God Subiaco Hospital to be cared for by the hospital’s experienced multidisciplinary team – a move that ultimately saved his life.

The patient’s surgery was undertaken by three St John of God Subiaco Hospital specialists.

Cardiothoracic Surgeon Associate Prof Jurgen Passage and Interventional Cardiologist Dr Eric Yamen performed a transcatheter aortic valve implantation (TAVI) to replace the patient’s aortic valve.

 Using the same percutaneous access, during the same anaesthetic, Vascular Surgeon Dr Peter Bray then repaired the aneurysm using endovascular surgery.

The entire procedure was conducted through two small skin punctures near each hip to access the blood vessels and insert a new valve in the heart and reline the abdominal aortic aneurysm using a stent-graft.

Dr Yamen said it was a complex case.

"The aneurysm was incredibly large and very dangerous, and the patient was too unwell for open heart surgery. If he hadn’t been treated quickly, he wouldn’t have survived," Dr Yamen said.

“The only way we could save his life was to combine the operations and perform them during the same anaesthetic. It required a lot of pre-planning, precision and expertise.

“Many hospitals are unable to undertake combined procedures such as this case, as they do not have the appropriate medical team. In fact, the patient was moved from another hospital to St John of God Subiaco Hospital to have this procedure."

St John of God Subiaco Hospital is one of only two private hospitals in Western Australia that is able to perform TAVI, a minimally invasive surgery which enables suitable patients to avoid traditional open heart surgery and benefit from a quicker recovery and less discomfort.

Approximately 5% of men over 50 years of age (especially smokers) have an aortic aneurysm, which can occur in the chest and/or abdomen. However, there are usually no symptoms until the aneurysm has ruptured, resulting in death in 90% of cases.

St John of God Subiaco Hospital Chief Executive Officer Prof Shirley Bowen said that the hospital was a centre of excellence in the treatment of cardiology and vascular issues.

“Our hospital’s experienced team of dedicated doctors, nurses and allied health professionals provide patients the latest in cardiology, cardiothoracic surgery, vascular surgery, coronary care and cardiac rehabilitation,” she said.