29-year-old survives life-saving hybrid cardiac surgery for ruptured thoracoabdominal aorta

A 29-year-old man suffering from a ruptured and massively dilated thoracic abdominal aorta has undergone a rare life-saving hybrid cardiac surgery in what doctors say is the first such reported procedure in South-East Asia.

Patient Saif Alam, a resident of Palamau district in Bihar arrived at Fortis Memorial Research Institute (Gurugram) in a critical condition with a ruptured aorta (the main blood vessel supplying blood to the entire body).   According to doctors, the condition carries an extremely high risk of death as the thoracic abdominal aorta is the body’s largest artery, responsible for carrying blood from the heart to vital organs.

Alam’s condition was initially mistaken for fluid accumulation in the chest at several hospitals in Bihar, where a chest tube was inserted. This led to further complications and uncontrolled internal bleeding. Over the following months, his health deteriorated sharply, with his heart function dropping to nearly 15%, confining him to bed due to the constant risk of sudden, fatal bleeding.  

Doctors at Fortis Gurugram found that the patient’s entire thoracic abdominal aorta was severely dilated and filled with extensive blood clots, critically compromising blood flow to organs such as the kidneys, liver and intestines. Given the severity of the damage and the patient’s poor cardiac function, conventional open surgery was ruled out due to the high risk of paralysis, organ failure and death.

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The surgical team, led by Dr Udgeath Dhir, Principal Director of Cardio Thoracic Vascular Surgery, opted for an advanced hybrid approach combining open bypass surgery with minimally invasive endovascular repair. The procedure involved placing a stent graft to seal the rupture and control bleeding, followed by a specialised technique known as aortic debranching to ensure uninterrupted blood supply to vital organs. Continuous spinal cord pressure monitoring was used throughout the surgery to reduce the risk of neurological damage.

Dr Dhir said the patient’s heart was functioning at about 15%, making immediate intervention critical. “Given the complexity, doctors adopted an advanced hybrid approach combining open bypass surgery with minimally invasive endovascular repair, beginning with a stent graft to seal the rupture followed by aortic debranching. The rare technique ensured uninterrupted blood flow to vital organs while protecting the spinal cord, with continuous pressure monitoring to reduce the risk of paralysis,” he said.

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Dr Anand Kumar, Senior Director, Cardiac Anaesthesia said “Effective management of such critical patients is essential because of their labile blood pressure, decreased cardiac performance, and heightened vulnerability to neurological damage. Therefore, anesthetic dosing must be meticulously determined and continuously monitored to ensure hemodynamic stability and prevent additional neurological harm.”