New heart surgery in Montreal reduces risks for patients, length of hospital stay

The technique was developed in France around ten years ago. It enables rapid treatment of patients who often don't have the luxury of waiting several weeks to have prostheses made to measure for them. (Courtesy: ICM) Jean-Benoit Legault

Two surgeons at Montreal's Sacré-Côeur Hospital recently became the first in Quebec to use a new technique that treats aortic aneurysms and dissections by avoiding open-heart surgery.

This new technique considerably reduces the risks for patients, as well as the length of their hospital stay and convalescence.

It also represents new hope for those patients who, until now, had few other options because their heart was too weak for traditional treatment, which involves an open-heart procedure during which the sternum is sawn in half.

"This allows us to treat patients in all kinds of scenarios, with all kinds of anatomies, but also in emergencies with prostheses to which we already have access," said Dr. William Fortin, who is a vascular and endovascular surgeon.

The technique, known as Physician Modified Endovascular Grafts (PMEG), involves drilling holes in a metal stent graft that doctors normally use to treat life-threatening aortic problems.

This modification allows the prosthesis to be used in the blood vessels that run from the aorta to the head and arm, explained Fortin.

These blood vessels, added his colleague Dr. Marina Ibrahim, a cardiac surgeon, extend more specifically from the transverse aorta: one to the right arm, one to the left and two to the head.

"This type of surgery carries a very high risk of stroke," she said. "For this surgery, we have to do a circulatory arrest during which we stop the perfusion of the brain. The brain is still protected, but the risk of stroke is very high."

While the new technique remains relatively complex for doctors, continued Dr. Fortin, "the benefits for the patient seem clear from the outset," particularly in terms of reducing the risks of surgery and the length of convalescence.

The new technique also represents new hope for patients who do not qualify for conventional surgery.

"We're looking for minimally invasive options (for these patients) who wouldn't have been able to tolerate open surgery," he said. "We want to offer these patients an option other than simply waiting for their pathology to eventually take them away."

The technique was developed in France around ten years ago. It enables rapid treatment of patients who often don't have the luxury of waiting several weeks to have prostheses made to measure for them.

"Otherwise," said Fortin, "patients with large aortic aneurysms, or whose aortas are torn outright, would not be able to be treated in a timely fashion."

"The novelty of this technique is that we can use a prosthesis we already have and adapt it to the specific anatomy of each patient," he explained. "It's really something new. We can treat anyone, anytime, whenever we need to."

That said, Fortin added, these procedures, however performed, carry significant risks for the patient "and we have to make sure we have the right option for everyone."

The first patient to benefit from this procedure at Sacré-Côeur Hospital went home after 48 hours, whereas conventional surgery usually involves a hospital stay of seven to ten days.

"It represents a great technical and professional advance," said Ibrahim. "It's worked, and we can start rolling out the technique to more patients."

- This report by The Canadian Press was first published in French on Dec. 9, 2023.