High Risk End stage
Coronary Artery Disease treated successfully with Beating Heart Surgery
Recently
we operated upon a 63 yrs old male who had CAD since last 10years and was very
symptomatic as he had myocardial infarction or heart attack couple of times
with the result his heart function went down to bare 15%. He was refused
intervention every where in view if the high risk involved in it. Even his one
of relatives in USA is a cardiologist and he also advised very high risk for
surgery. He went into heart failure a
number of times and was treated at local hospitals for that. Looking at the
heart function he was refused surgery but treated medically or was suggested
PTCA in one of arteries with doubtful benefit..
He came to us again and on ECHO his ejection fraction was only 15%, dilated
heart and muscle looked to be thin. His angiography done in NCR showed severe
triple vessel disease. Dilated heart with low heart function makes it very high
risk surgery. His “Euro score” a criteria to assess risk of surgery based on
the clinical and investigative parameters was 14 indicating a mortality of 40%.We
decided to do a further work up and went for PET scan(positron emission
tomography) which gives us a very good idea that whether the heart muscle is viable
or not and can it be revived by revascularization. Luckily for him PET showed
good muscle with reasonably good viability in most of areas except two areas. Based
on this we came to a conclusion that he will benefit if preoperatively he
tolerates the procedure. We decided to offer him a beating heart surgery a new
technique adopted with us for last 10years where you avoid heart lung machine
and its side effects which is very crucial in such cases for good recovery.
Intra-operatively we used special gadgets to monitor functioning of the heart
continuously with continuous cardiac output catheter. Adequate preparation i.e.
decongestion and putting intra-aortic balloon pump (IABP) preoperatively was
done which helps heart in giving more blood. After 24hrs we took him for OPCAB(beating
heart surgery) and did three by- passes on his heart. His lung pressures were
very high which were manipulated with drugs and they settled down after the
grafting. He sustained the procedure well and in the post operative period did
very well. IABP was removed on 3rd day and all drugs to help heart were off by
5th post operative day. He was mobilised and shifted to HDU to see
his early mobilization under close supervision. He was very comfortable in
walking around extensively with normal parameters and was discharged on 9th
day. Before discharge his heart function came up to 30% from 15% a massive
improvement. It will further improve but slowly. These patients are ideally
suitable only for heart transplant but facilities for this in our country are
few and too expensive to maintain it also. If left untreated the prognosis is
not very good as low output state and repeated heart failure damages the other
organs like kidneys, liver and they succumb to multi-organ failure. Careful
planning and extra care with new technologies help saving such lives and gives
them quality of life also.
Thus
“Time is muscle and do not lose it in waiting.” By- pass surgery done at appropriate
time in stable condition is the best thing to happen to heart and it increases
your quality of life and prevents further set- backs to heart muscle. He was
operated by a team headed by Dr Virendar Sarwal, In charge Dept. Of CTVS Max
hospital, Dr Ajay Sinha, Dr Arat Nahak, Dr Srinivas, Dr Goswami, Dr Shailender
at Max Superspeciality Hospital, Mohali.
