Mike A stable after surgery

The open heart surgery performed on First Gentleman Jose Miguel "Mike" Arroyo was a success, but his condition must be closely watched in the next 48 hours, doctors at the St. Luke’s Medical Center reported yesterday.

The 60-year-old Mr. Arroyo would have to use a ventilator until tomorrow even as he continued to show signs of recovery, his doctors said last night.

The First Gentleman’s main attending physician Dr. Juliet Gopez-Cervantes said Mr. Arroyo, who awakened briefly from sedation yesterday morning, was showing positive signs of fully recovering within the next weeks.

However, she said they had to sedate him again after he woke up to lessen stimulus that could raise his blood pressure.

President Arroyo remained by her husband’s side in the hospital, and at one point even offered to donate blood to him, an offer which was declined by the hospital.

Cervantes said that the entire procedure, which included a triple bypass and an aneurysmectomy, took around 10 hours but was "uneventful so far." She said that had the operation been delayed even by a mere 30 minutes, the consequences could have been "catastrophic."

When asked whether Mr. Arroyo was still in danger, she said: "Relatively yes, until tomorrow."

"We opted to maintain that (ventilator). When he’s on the ventilator, he’s already breathing on his own so the ventilator will support but no longer be breathing for him the way it was when he was under surgery," Cervantes told reporters.

She said that Dr. Rommel Cariño, reputedly the best cardiovascular surgeon for such procedures, performed the operation.

She pointed out that the First Gentleman already woke up yesterday and "was able to open his eyes and follow commands and he was able to localize and follow instructions."

"That is a very big blessing because the way he recovers (is) faster than we thought (he would)," Cervantes said.

Cariño reported that after he performed the emergency operation to address the dissective aneurysm, he had to do triple bypass surgery on the First Gentleman as he discovered that he also was suffering from coronary artery disease.

"We also did triple bypass because the heart vessels were also obstructed and putting in a graft into those obstructed arteries will improve heart function during the peri-operative period," he said.

He noted that the emergency operation was necessary because the rate of rupture of the aorta within the first 24 hours was at around 50 percent, which is considered very high.

Cutting off the blood flow

"Among the patients with dissective aneurysm, the First Gentleman’s condition has the highest risk because it involves the aortic arch. In that case, we cannot repair that aortic arch without stopping the circulation of the whole body," Cariño said.

By stopping the circulation of blood for the entire body, doctors said Mr. Arroyo runs the risk of having vital organ failure.

Mr. Arroyo is currently confined in the cardiovascular recovery room, still incubated and using a respirator.

The two doctors stressed that the next 48 hours would be the most critical for the First Gentleman as the performance of his vital organs would have to be closely monitored.

Cariño said that a "dysfunction" of the vital organs is expected whenever blood circulation is completely cut off so they are closely monitoring for these problems to arise within the next 48 hours.

"In the meantime, the First Gentleman is doing well. We are monitoring the functions of the different vital organs," he said.

"The critical point, we were telling you there might be some neurological deficit or some manifestations of some neurological problem after that time that there was no circulation to the brain. We, at this point in time, are not seeing any. So, no neurologic deficit whatsoever. I hope it continuously be this way and more improvement tomorrow," Cervantes said.

Prayers still needed

President Arroyo, through Cervantes, thanked the public for the prayers offered for her husband.

"Please keep on praying. We need your prayers a lot," Cervantes quoted the President as saying.

Cervantes said that the President actually offered her blood for her husband but the hospital declined since it had more than enough to cover for the procedure.

Cariño said that around 50 percent of the patients suffering from dissective aneurysm die within the first 24 hours of the rupture of the blood vessel.

Not many people, though, suffer from this condition and it is considered rare. According to Cariño, this type of procedure comprises only one percent of all open heart procedures they perform.

Stressing Mr. Arroyo’s precarious condition, Cervantes said had the surgery been delayed by 30 minutes, the weak portion of his aorta could have ruptured and his medical condition would have rapidly deteriorated.

According to the surgeons, the aorta was already leaking during the operation and there were some blood clots around the vessel, she said.

"It (surgery) was just at the right time. Probably 30 minutes or more of delay will really put him at a very catastrophic condition… a matter of minutes more, there was a high probability that we would have lost the First Gentleman," Cervantes said.

She said tension in Mr. Arroyo’s suite in SLMC suddenly ran high after he was diagnosed as having a dissecting aortic aneurysm. Within minutes of his diagnosis, Mr. Arroyo was already being sedated, prepared for surgery and wheeled to the operating room.

"You can just imagine the situation yesterday when we established the diagnosis. In a matter of minutes, we had to rush him to the operating room, get enough blood. The surgeon, in a matter of minutes, put him into sedation and then anesthesia and so on, the procedure lasted almost 10 hours, so practically the whole night we were monitoring, we were praying for everything," Cervantes said.

Critical phase

"We have passed the very, very critical area, that is that act of surgery itself. Now we are on the second phase, the critical area that is the observation after surgery," she said.

She said doctors are looking for more encouraging signs of recovery following the procedure.

"That (signs of recovery) is what we are waiting for right now. That’s why we are asking everybody to help us pray. We have done the surgery, the most important part. We are giving, besides the support we are giving medically, observation hoping that (despite) that five-minute thing, everything will be fine," she said.

"Doing this operation involves problems in different vital organs that’s why it would take a long time to recover comparing it to the run-of-the-mill open heart cases. We’ll make sure that the vital organs are functioning well before we discharge our patient," Cariño said.

Barring any complications, Cariño said that Mr. Arroyo would probably be able to fully recover in about 10 days or two weeks.

After recovering, the First Gentleman would have to undergo some serious changes in his lifestyle.

Cariño said that Mr. Arroyo would have to engage in an active lifestyle, avoid smoking and eating fatty food, control his diabetes as well as hypertension.

Cervantes pointed out that Mr. Arroyo is neither a smoker nor a diabetic so she expressed confidence that all of the risk factors would be in check.

Responding to queries about reports that patients who undergo an aneurysmectomy have only 10 years left to live, Cariño explained that depending on the development of the aneurysm of the remaining vessels and the control of the risk factors, then the patient can easily live 20-30 years more after the procedure.

Hypertension

In the end, Carino noted that what ultimately caused the problem for the First Gentleman was hypertension.

"The precipitating factor is the hypertension; weakness of the blood vessels, lack of elastic tissues, precipitated by high blood pressure, it can just dissect the layers of your aorta," he said.

While accompanying the President and their family on their annual summer retreat in Baguio City, Mr. Arroyo was rushed to the St. Louis Hospital after complaining of abdominal pains.

The First Gentleman was initially diagnosed as suffering from chronic gastritis.

He was later on transferred to the St. Luke’s Hospital where the much more serious problem was detected.

Cariño did not fault the doctors at the Baguio hospital for failing to find the actual problem considering how rare the condition was.

"He developed severe chest pain, back pain and the abdominal pain was only secondary to the compression of the blood supply of the vital organs, secondary to the dissection of the blood supply. This is not a common disease," he said.

Business as usual

Meanwhile, Vice President Noli de Castro, who went to St. Luke’s yesterday to check on the First Gentleman, said that it would be business as usual at Malacañang and the entire government even though the President is with her husband at the hospital.

De Castro said that the President even instructed him to follow up the assistance of the government to the victims of the fire in Barangay Addition Hills in Mandaluyong City.

He said that the President was in high spirits and just wanted to thank the people for their prayers for her husband.

The Cabinet-level National Nutrition Council meeting scheduled yesterday also pushed through without the President.