Royal Brompton Hospital team performs pioneering heart procedure in UK first

A pioneering procedure to treat an aneurysm in the aortic arch, using minimally invasive keyhole surgery, has taken place for the first time in the UK at London’s Royal Brompton Hospital.

The aortic arch is a section of the aorta, the largest blood vessel in the body. An aortic arch aneurysm is an abnormal swelling of the aorta which, if left untreated, can burst and be life-threatening. Typically, treatment for this type of aneurysm involves complex, open-heart surgery. However, the hospital’s experts have used keyhole surgery to insert a stent, a tube inserted into a blocked passageway such as a blood vessel to keep it open, to repair an aortic arch aneurysm in a 78-year-old patient, who was deemed too fragile for traditional open-heart surgery. The stent used is specifically designed to treat problems in this part of the aorta.

The team, led by consultant interventional cardiologist Professor Christoph Nienaber and consultant cardiac surgeon Mr Ulrich Rosendahl, carried out the procedure in Royal Brompton Hospital’s hybrid operating theatre, a traditional operating theatre but with the imaging capabilities of a catheter laboratory.

It was performed in two stages while the patient was under light general anaesthetic. In the first stage, consultant vascular surgeon Mr Maziar Mireskandari performed carotid to carotid artery crossover bypass surgery, a procedure used to maintain blood flow to the brain and prevent stroke – one of the major problems associated with keyhole surgery.

In the second stage two Nexus stent components, which are custom-sized to each individual patient, were inserted into the aortic arch using keyhole surgery through the patient’s groin to repair the aneurysm and prevent it from rupturing. Due to the minimally invasive nature of the procedure, the patient was able to leave her bed very quickly and was discharged in a few days, with her recovery time reduced from several weeks.

The team is the first to use this stent in the UK, and the first to treat an aneurysm encompassing the entire aortic arch by combining crossover bypass surgery with keyhole surgery.

Professor Nienaber said: “We’re delighted that this combined procedure went so well and achieved such a terrific result for our patient. It took careful planning and was made possible through a highly skilled, multidisciplinary team, involving surgeons, anaesthetists, radiologists and cardiologists, and lots of supportive team spirit.”

“We’re proud to be the first in the UK to complete this pioneering procedure and look forward to establishing this innovative technique at the Trust so more patients can benefit.”