Medical Moment: Protecting the brain during heart surgery

Published: Oct. 20, 2022 at 5:59 PM EDT
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(WNDU) - Aortic dissection is a rip in the aorta.

And since the aorta carries blood from the heart to the circulatory system, when it splits open, it usually means sudden death!

For some patients lucky enough to make it into an operating room, surgeons are utilizing a “super cool-down” of the body.

Aortic dissection is caused by a weak aorta, the artery that carries blood from the heart to the body. When it ruptures, it’s often deadly.

“Fifty percent of the time, people who present with dissection don’t make it to the hospital,” said Truc Ly, a cardiothoracic surgeon at Baptist Health System San Antonio.

Meaning time is critical.

“The way we’ve gotten better results is understanding how to protect the brain during surgery,” Dr. Ly explained. “What we call antegrade cerebral protection.”

Doctors do this by using hypothermia induction, or cooling the body to preserve the brain during a heart-lung bypass.

“What we call hypothermic circulatory arrest, it’s where we cool the body down and stop all blood flow to the rest of the body,” Dr. Ly said.

Sandra Fernandez loves to spend time in her kitchen, but recently, surgeons needed to treat an aortic aneurysm. Dr. Ly removed Sandra’s aneurysm and replaced her heart valve during the operation. Doctors induced hypothermia to protect her brain function.

“Whatever we’ve been able to fix, will stay that way for the rest of her life,” Dr. Ly explained.

Sandra woke up in recovery to a very happy family. Now, she’s enjoying life, cooking for her kids, and using her grandmother’s precious recipes.

“I feel happy because I say, ok, I’m here again, I survived!”

Although once considered an operation that should be done by a qualified cardiac surgeon, it still remains one of the highest-risk procedures.

The best results are achieved in centers that provide a specialized aortic service. Cedars-Sinai has developed such a service—the Cedars-Sinai Specialist Aortic Service (CSSAS). It goes beyond the expertise of the individual cardiac surgeons who provide the dedicated on-call rotation for aortic dissection.

CSSAC is comprised of highly specialized anesthesiologists, perfusionists, intensivists, cardiologists, and vascular surgeons.