30.04.2025 12:17
A 52-year-old man who was hospitalized in Antalya with chest and back pain was found to have an aortic tear in his heart. The man was taken into emergency surgery, during which his body temperature was lowered to 22 degrees, and he experienced "temporary death" for 100 minutes. The doctor stated that the 7-hour surgery was successful and that there were no neurological findings, saying, "Only we and God know what we went through."
Mustafa Şahin, who came to Antalya City Hospital 2 months ago with complaints of sudden heart and back pain, had his aorta, which was determined to be completely torn, replaced with an artificial vessel using the "elephant trunk" technique, which is rarely performed in medicine.
FIRST HE DIED, THEN HE CAME BACK TO LIFE
During the 100-minute portion of the surgery, the patient's entire body circulation was stopped, and only blood circulation to the brain was maintained, cooling the body to 22 degrees. The patient, who was "temporarily dead" for 100 minutes, regained his health without any neurological findings at the end of the surgery performed by the team led by Prof. Dr. Nevzat Erdil, the Head of the Cardiovascular Surgery Clinic and Education at Antalya City Hospital Health Application and Research Center.
"25% OF PATIENTS DIE BEFORE REACHING THE HOSPITAL"
Prof. Dr. Nevzat Erdil stated that the patient was initially evaluated for a heart attack in the emergency room where he was brought by ambulance with severe chest and back pain. He noted that detailed examinations revealed acute Type A aortic dissection, saying, "About 25% of these types of patients die suddenly before reaching the hospital. In patients who can make it, death can occur if the diagnosis is delayed." Prof. Dr. Erdil explained that the symptoms of aortic dissection can be confused with many diseases, emphasizing the need to suspect aortic dissection in patients presenting with such a condition, to make a rapid diagnosis, and to quickly transfer them to a center where this surgery can be performed.
EMERGENCY SURGERY WITHIN 45 MINUTES
Prof. Dr. Erdil explained that they took the patient into emergency surgery within 45 minutes after the diagnosis was made, stating that in such patients, external bleeding or ischemia (nutritional problems) in organs can occur. He said, "Fortunately, there was no such situation in our patient. It was a good thing that we took him to surgery quickly without any damage to the organs and without wasting time. This increases our chances of success."
CIRCULATION STOPPED FOR 100 MINUTES
Prof. Dr. Erdil stated that in aortic dissection surgeries, it is necessary to stop the body's blood circulation for a certain period to protect and nourish the brain, and that the body should be cooled to 20-25 degrees. He mentioned that they do not want this duration to exceed 30-40 minutes. Prof. Dr. Erdil noted that they saw that Şahin's aorta was torn from end to end and that the torn aorta was replaced with an artificial vessel using the technique referred to in medicine as "elephant trunk." He stated that during the approximately 7-hour surgery, blood circulation was stopped for 100 minutes, and the body was cooled to 22 degrees to prevent damage to the patient's brain and other organs, adding that during this time, the patient first died and then came back to life.
"WE DISCHARGED HIM WITHOUT NEUROLOGICAL FINDINGS"
Prof. Dr. Erdil emphasized that he had some concerns regarding the length of the surgery, stating, "Thank God, we discharged our patient healthy without any neurological findings and sent him home. Normally, the circulation stop time is 30 minutes, but we applied a 100-minute stop time for this patient. However, since we were able to protect the brain well, we did not experience any problems. The patient's biggest advantages were the absence of any findings in the organs, coming to us in time, and the absence of malperfusion (nutritional problems) in the organs. Even though we performed a major surgery, the likelihood of death is very high when the organs are affected."
“ONE OF A FEW CASES I’VE ENCOUNTERED IN MY 30-YEAR SURGICAL CAREER”
Prof. Dr. Erdil stated that it is necessary to perform the most accurate surgery as soon as possible to ensure the patient's survival in such cases, adding that this patient is one of the few cases he has encountered in his 30-year surgical career. He noted that such surgeries can only be performed in fully equipped, experienced centers, stating that despite Antalya City Hospital opening just a year ago, they are able to perform these types of surgeries with a team of specialists available 24 hours a day.
“ONLY WE AND GOD KNOW WHAT WE WENT THROUGH”
Op. Dr. Şahin Kapan, who was part of the surgical team, stated that he could not even imagine how to perform the "elephant trunk" technique they learned from books. Op. Dr. Kapan said:
"We learned how to perform this surgery by participating in it under the leadership of Prof. Dr. Erdil. I may never see such a surgery again in my life. My professional life may not be enough. Even though I have 20 years of experience in cardiology and vascular surgery, it was a very long surgery. Only we and God know what we went through. Thank God our patient is alive, healthy, and coming for check-ups. This is very pleasing for us."
THE BIGGEST RISK FACTORS: AORTIC DILATION AND HIGH BLOOD PRESSURE
Assoc. Prof. Dr. Gökhan Özerdem, who was also part of the surgical team, provided information about aortic dissection. He emphasized that the dilation of the aorta is a detectable condition, stating that the biggest risk factors for aortic rupture are aortic dilation and high blood pressure. Assoc. Prof. Dr. Özerdem explained that patients diagnosed with aortic dilation are monitored with physician check-ups every six months, stating that surgery is not considered for patients with an aortic diameter below 50 millimeters, and surgery is performed when it exceeds 50 millimeters. He emphasized that some patients with limited aortic dilation may also be considered for early surgery if they have accompanying heart conditions.
REACHING THE HOSPITAL IS IMPORTANT
However, Assoc. Prof. Dr. Özerdem pointed out that in recent years, ruptures can occur without dilation of the aorta, noting that the causes of aortic rupture include high blood pressure, high blood lipids, lesions in the vessels, and genetic factors. He emphasized that the most important point in aortic rupture is being able to reach the hospital, stating, "We lose about 80% of patients within the first 72 hours if there is no surgical intervention."
Some patients die without ever reaching us. In these patients, there is a sudden rupture that opens into the lungs, into the heart, or towards the pericardium. Those patients are generally the ones who never reach us. Even if they do, the heart has already suffered serious damage. Even if the surgical intervention is perfect, the process can be prolonged and the outcome can be poor," he said.
"I SAID I HAD PAIN, I DON'T REMEMBER THE REST"
Mustafa Şahin, who regained his health after a long and difficult surgery, stated that he had no prior knowledge or complaints about his illness. Noting that he immediately called an ambulance when he felt a sudden pain in his heart and back, Şahin said, "The ambulance brought me to the hospital. Our doctors did what was necessary and detected the aortic rupture." He mentioned that he could remember very little of what he experienced, saying, "Our doctors asked me a few questions, they asked, 'Did you have a fight with someone?' I said I hadn't fought with anyone. I just said I had pain. I don't remember the rest," he said.
"WHEN I OPENED MY EYES, I ASKED 'WHAT HAPPENED TO ME?'"
After the intensive care process, Şahin recounted that when he opened his eyes, he asked, "What happened to me?" and learned about his experiences from his wife, Fadime Şahin (46). He mentioned that he thought he had undergone angiography by himself after the surgery and expressed his surprise when he learned that the aorta had ruptured. Thanking his doctors, Şahin said, "Our professors showed great interest, care, love, and compassion. Thank you very much."
"I STARTED EVERYTHING AGAIN"
Şahin, who expressed that he was both surprised and happy to have survived such a risky surgery, said, "Our professors said that my survival is a miracle. I embraced my wife and children with love. I feel like I have been reborn into life. I have started everything again now," he said.