No Pulse, No blood Flow, A Finite window: A successful 10-hour Aortic Arch Reconstruction at KIMS HOSPITALS, KONDAPUR

In a remarkable feat of advanced cardiovascular engineering and clinical precision, the cardiac surgical team at KIMS Hospitals, Kondapur, successfully performed a rare and highly complex 10-hour surgery on a 64-year-old retired government teacher from Medak district, bringing her back from the threshold of planned, clinical standstill.

The patient, who had been managing hypertension for a decade, experienced a sudden onset of excruciating chest pain radiating to her back, accompanied by sweating and vomiting in early hours of 17th September. Initially after being symptomatically treated  at a local facility, she was referred to Kompally as her pain persisted. they utilized a CT scan to accurately diagnose a life-threatening emergency: an Acute Dissection of the Ascending Aorta extending directly into its branch vessels. Recognizing the critical complexity of the condition, the patient was immediately transferred to the specialized, high-volume cardiac unit at KIMS Hospitals, Kondapur.

A multi-disciplinary team under Chief Cardiologist, Dr. Ravi Kumar Aluri and Chief Cardiac Surgeon, Dr. Nisarga immediately evaluated the patient. She was then taken up  for a gruelling 10-hour procedure consisting of an ascending aorta replacement using a specialized gelatin-sealed polyester vascular graft, debranching of the innominate artery, and the re-implantation of the left common carotid artery, the blood vessels supplying the brain

To successfully reconstruct the main artery supplying blood to the brain and body, the surgical team had to induce a state of suspended animation. Utilizing profound hypothermia, the team cooled the patient’s body temperature down to 18°C   where cellular metabolism essentially paused. For a critical window of time of about 30 minutes, the heart was completely still, the bypass pump was turned off, and the patient had no pulse, no blood pressure, and zero blood flow—a planned, reversible standstill designed to buy the surgical team a tense, bloodless field to rebuild the riverbed of life. During this time, external ice packs were used to further cool the brain as a measure to bring down its metabolic requirements.

"To understand the gravity of this surgery, it is important to realize that this procedure requires us to take the patient to the absolute edge of life and safely bring them back," said Dr. Nisarga, Chief Cardiac Surgeon at KIMS Hospitals, Kondapur. "During the critical phase of this surgery, the patient had no heartbeat, no pulse, and zero blood flow to their body or brain. We cooled the patient’s body temperature down to a state where cellular metabolism essentially stops, giving us a very narrow, incredibly tense window of time to remove the diseased portion of the aorta and reconstruct the aortic arch. It is a race against the clock, where every single second dictates the patient's chance of waking up. Once the reconstruction was complete, we slowly rewarmed the blood, restarted the heart, and brought the patient back to life."

Dr. Nisarga emphasized that the success of this high-stakes operation relied entirely on a synchronized medical front. "A surgery of this magnitude is never the work of one person. It is a symphony of precision. I want to publicly recognize the extraordinary coordination of our entire team here at KIMS Kondapur—our cardiac anaesthesiologists, perfusionists, surgical nurses, and intensive care staff. When a patient’s life is suspended in our hands, it is the absolute trust and expertise of this multidisciplinary team that ensures they wake up."

The successful life-saving operation was executed by a premier clinical team led by Chief Cardiac Surgeon Dr. Nisarga, Senior Cardiac Surgeon Dr. Sameer Chauhan, Cardiac Surgeon Dr. Vineeth, and  the precise coordination team included Cardiac Anaesthesiologists Dr. Gorintha and Dr. Bhavani, Senior Surgical Assistant Mr. Manoah, Senior Clinical Perfusionists Mr. Jagan Mohan and Mr. Dayakar Swamy, alongside Junior Perfusionists Mr. Abhishek and Ms. Mounika.

Following the flawless reconstruction, the patient was safely brought back to life as her heart was restarted, and was shifted to the ICU with minimal supports. She was off the ventilator in just a few hours and was ready to tell her tale to the world the very next day with no neurological issues , marking a monumental victory for regional healthcare and showcasing the world-class surgical capabilities available at KIMS Hospitals, Kondapur.