Prayagraj: Doctors at Max Super Speciality Hospital, Lucknow, performed a rare and complex surgery using “Frozen Elephant Trunk” procedure -with replacement of ascending aorta, aortic arch, debranching of brain arteries and aortic-stented hybrid graft for descending thoracic aorta on a 27-year-old man from Prayagraj. The patient was diagnosed with a large aortic dissection around 8 cm width (impending rupture) and extending from ascending aortic root to abdominal aorta (a tear in the inner layer of the largest blood vessel of the body). Left untreated, it could have ruptured at any time, leading to instant death.
A team of doctors led by Dr. Vijayant Devenraj, Director & HOD – Cardiothoracic & Vascular Surgery (CTVS) at Max Super Speciality Hospital, Lucknow, performed a marathon 7-hour surgery that involved stopping all the blood circulation of the body, including heart, brain, organs like kidney, liver, etc. under deep hypothermic total circulatory arrest (DHCA) where patient was cooled to 18 °C and then surgery performed.
Mr. Alok, the patient, had been experiencing chest pain and shortness of breath for nearly five months but assumed it was due to acidity or chest congestion. His condition worsened over time, leading his family to seek specialized care at Max Hospital, where detailed evaluation and CT Aortogram revealed the dangerously large tear in his aorta (dissection of aorta). He was also suspected to have Marfan Syndrome, a congenital connective tissue disorder that predisposes patients to such vascular complications.
Explaining the case, Dr. Vijayant Devenraj, said, “Mr. Alok had been experiencing symptoms for months but did not seek expert advice, assuming it was gas or chest congestion. However, as his condition did not improve with persistent throbbing chest pain and severe dypsnoea, his family decided to bring him to specialised care. This turned out to be a very rare and difficult case, especially because he was so young. He had a large tear about 8 cm width in diameter (normal 2.5 to 3 cms) extending from aortic root to abdominal aorta just proximal to renal arteries. It also affected important arteries that supply blood to his brain, chest and vital abdominal organs. We chose to perform a rare and complex hybrid surgery “Frozen Elephant Trunk”. It’s named that because of how it looks. In this surgery, we replaced the damaged part of the aorta- complete replacement of ascending aorta, aortic arch, brain arteries and placed a stiff tube (called a stented aortic graft) into the lower part of thoracic aorta, all in one operation.”
Explaining further about the surgery, Dr. Vijayant Devenraj, said, “To work safely on the heart and main arteries, the patient’s body was gently cooled to about 18 °C, and total body’s blood circulation was paused for around 35–40 minutes. This allows safer surgery in critical aortic arch disease cases. The surgery lasted for about 7 hours. We successfully performed replacement of the ascending aorta with debranching of the arch vessels, along with stent grafting using the frozen elephant trunk technique and reconnected the brain’s arteries all during the cooling and circulation-stopped period.”
The patient was shifted to the ICU after surgery and kept on ventilator support for two days. Despite the scale and complexity of the operation, blood loss was minimal, and recovery was smooth. The patient was discharged in a stable condition after ten days of the surgery. The successful case highlights Max Super Speciality Hospital, Lucknow’s, advanced expertise in managing some of the most complex cardiac and vascular conditions, combining world-class technology with skilled surgical precision.
