High Risk End stage Coronary Artery Disease treated successfully with Beating Heart Surgery

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 5^th 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 9^th 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.