In a first for Israel, a highly trained and talented cardiac team at Hadassah Hospital Ein Kerem are repairing aneurysms in the aortal arch with a minimally invasive procedure replacing more risky open-heart surgery. This surgery take less time, and the patients also recover more quickly, avoiding serious complications.

Instead of performing open-heart surgery, with all its risks, to repair a defective aortal arch that has an aneurysm – a bulge in a blood vessel caused by a weakness in the blood vessel wall – interventional cardiologists at the Hadassah-University Hospital in Jerusalem’s Ein Kerem are the first in Israel to fix it by minimal catheterisation.

The first case, on an elderly man at high risk of death, was performed in May without official Health Ministry approval on compassionate grounds. There have been two more cases since then. The fourth patient who underwent the two-and-a-half-hour procedure, Meir Yitzhak, is only 55. The implant is threaded toward the heart via arteries in the leg and/or the arm and covers the balloon-like aneurysm in the aorta that then doesn’t have to be removed.

Open-heart surgical repair of an aortic arch aneurysm takes six to eight hours, and is high risk with a long recovery and dangers of complications, said Dr. Gabby Elbaz-Greener, who performed the procedure along with Coronary Catheterisation Department Head Dr. David Planer; Prof. Amnon Korah, a veteran Hadassah cardiac surgeon who has replaced damaged aortic arches in open-heart surgery; Prof. Ronen Be’eri, Director of the Echocardiography unit; and Anaesthesiology resident Dr. Tamer Abu Jreis.

Before the catheterisation, each patient undergoes a full clinical and imaging evaluation by the team in order to check suitability for the operation. Due to the complex geometric structure of the aortic arch, each patient is simulated on a 3D printed anatomical model. Fixing the arch is complicated because three blood vessels are connected to it, she added. Aneurysms often rupture suddenly in patients of all ages, and nothing can save them – even if they are in a hospital when it occurs, said Elbaz-Greener.

From clinical trials to the operating room

Several hundred patients in Europe and New Zealand underwent implantation of the Dacron implant call Nexus in clinical trials. Developed by the Endospan Company in Herzliya Pituah – it now has certification from the European CE authority after the product was deemed to meet EU safety and health requirements. Hadassah was chosen by the company to be the first in Israel to use it because Planer was deeply involved in the graft’s development. They published an article on the first catheterisation procedure in the Annals of Surgery.

Elbaz-Greener estimated that about 20 Israeli patients a year will need and be suited for the graft, and that the world market for it will include thousands of patients a year. As the graft becomes better known, many patients will demand it and cardiologists will learn to perform it because of the safety, short recuperation process and other benefits, she added. Doctors from Sheba Medical Centre at Tel Hashomer have visited the Hadassah team to learn how to perform the special catheterisation.

Hadassah Cardiology Chief Prof. Ofer Amir said, “The aorta, especially its ascending part and the arch it creates in the thorax, is a therapeutic challenge because of the significance of a disruption in the blood flow in the main artery that supplies blood that leaves the heart to all the other organs of the body. Until today, a major operation involving the opening of the chest following a long recovery was the only treatment. Thanks to Israeli development and Hadassah’s skilled medical team, today it is possible to perform catheterisation medical procedures on the aorta and avoid surgery.”

Hadassah Hospital Director-General Prof. Yoram Weiss commented, “The treatment of aortic arch diseases is one of the most complex in modern medicine, when the treatment with open heart surgery – the only option until now – carries a high risk of mortality and brain damage. Several years ago, Endospan began developing a device for catheterisation to reduce the risk of the operation, and we have seen amazing results. Today, cardiology patients receive excellent treatment here which in the past we could only dream of.”

Editor’s Notes:

An excerpt from an article by JUDY SIEGEL-ITZKOVICH, published in the Jerusalem Post

Hadassah UK is currently supporting the New Cardiac Critical Care Centre at Hadassah Mount Scopus, which provides medical care for hundreds of thousands of residents of northern Jerusalem and many surrounding communities.

The New Catheterisation Lab at Hadassah’s Mount Scopus campus has significantly improved cardiac care for all residents of Jerusalem. Click here to find out more.