Doctors at UT Southwestern Medical Center became the first in Texas—and the second in the U.S.—to perform a new procedure to repair the aortic arch above the heart without opening the chest, an approach that the lead surgeon says could start to take off in the wake of his first success.
In April Dr. Carlos Timaran, a vascular surgeon at UT Southwestern, performed the minimally invasive procedure on 77-year-old James Isbon, who had been suffering from an aneurysm in his aortic arch. The method requires two small neck incisions and needle-hole access in the groin. Timaran worked with cardiovascular surgeons to thread stent grafts through arteries in the patient’s neck and groin to repair the bulge above his heart.
Isbon, who had been experiencing fatigue and an irregular heartbeat, says he couldn’t have had surgery any other way. He had open heart surgery back in 1993, and he says going through the same procedure again could have been deadly.
“With my age and my health, it would’ve been very dangerous,” Isbon says. “This was a lifesaver.”
Timaran introduced Isbon to the new procedure, which uses catheters to carry stent grafts that stabilize the aortic arch. Doctors guide the catheters to the aortic arch with x-ray and ultrasound, and throughout the procedure, the heart keeps beating.
Timaran says he anticipates that the procedure will grow in popularity following Isbon’s recovery; he expects to perform two or three similar procedures by the end of the year. He says the price is similar to or cheaper than traditional surgeries, but that’s not its biggest achievement.
First, it’s the shorter procedure and recovery. The surgery takes about half the time of an open heart surgery, two or three hours as opposed to five or six. Isbon returned home five days after his procedure.
Second, it’s the many patients who could benefit.
“It allows us to take patients who are not eligible for open heart surgery—initially, that will be the kind of patient we will be treating. But once we prove that this works, it will expand to standard-risk patients,” Timaran says.
Isbon’s procedure on April 23 was just the seventh in the world, and Timaran had to obtain special approval from the FDA to do it. He’s one of only two U.S. surgeons to have implanted such devices under an “investigational device exemption” protocol, which allows stent grafts to be custom-made based on computer models of patient CT scans.
Timaran says he began transitioning toward new operation methods back in 2007, when UT Southwestern began hybrid surgeries, which combine standard heart surgeries with catheter-based methods. Then he collaborated with surgeons and specialists in the U.S., Canada, and Latin America using the most minimally invasive procedure. The new procedure is total endovascular repair, one step further than hybrid repair, because it isn’t technically surgery at all.
During Isbon’s follow-up appointment on May 23, the CAT scan showed a completely sealed aneurysm. Now Isbon says he hopes to get back to feeding birds and mowing his lawn, and he’s grateful to have been a part of this groundbreaking operation.
“I’m looking forward to this being successful enough that the FDA will approve this for surgeons across the country that train for it,” Isbon says. “This has saved my life, but I think there can be thousands of lives saved over the years by this procedure.”