US doctors `vacuum` 2-foot blood clot out of patient`s heart

Los Angeles: US doctors have successfully vacuumed a deadly two-foot blood clot out of a 62-year-old patient's heart to save his life, during a three-hour-long medical procedure that spared the man an open heart surgery.

Todd Dunlap from California arrived at Ronald Reagan UCLA Medical Center's emergency room on August 8 suffering from shortness of breath, fatigue and extreme cold.

When a CT scan revealed a 24-inch clot stretching from his legs into his heart, doctors feared the mass could lodge in his lungs, blocking oxygen and killing him instantly.

Dunlap was given option of having an open-heart surgery or undergo a new minimally invasive procedure using a device called AngioVac to vacuum the massive clot out of his heart.

The procedure had never been successfully performed in California.

Dunlap chose the second option and underwent the procedure on August 14. A week later, he was home, full of energy and eager to play on the floor with his 9-month-old grandson.

A team of radiologists and cardiovascular surgeons slid a tiny camera down Dunlap's oesophagus to visually monitor his heart.

They guided a coiled hose through his neck artery and plugged one end into his heart, against the clot. They threaded the other end through a vein at the groin and hooked the hose up to a powerful heart-bypass device in the operating room to create suction.

"Once in place, the AngioVac quickly sucked the deadly clot out of Dunlap's heart and filtered out the solid tissue," said Moriarty.

"The system then restored the cleansed blood through a blood vessel near the groin, eliminating the need for a blood transfusion," said Moriarty.

The procedure lasted three hours. Doctors observed Dunlap for three days in intensive care before transferring him to the cardiac ward and discharging him four days later.

"Retrieving a clot from within the heart used to require open-heart surgery, resulting in longer hospitalisation, recovery and rehabilitation times compared to the minimally invasive approach provided by the AngioVac system," said Dr Murray Kwon, a UCLA cardiothoracic surgeon who collaborated on Dunlap's procedure.

Similarly, a clot-busting drug known as a tPA typically takes three to four days to work. In Dunlap's case, his physicians tried tPA first, but it failed due to the clot's large size and density.

"The AngioVac was the last resort for Dunlap. The clot clogged his heart chamber like a wad of gum in a pipe. Every moment that passed increased the risk that the clot would migrate to his lungs and kill him. We couldn't have asked for a better outcome," said Moriarty.

"I'm thrilled that I didn't have to go through open-heart surgery," said Dunlap.

"This procedure is a great option for the older, frail person who wouldn't survive open-heart surgery. Without an alternative like this, he's a goner," said Dunlap.