· Patient presented with critically blocked and calcified heart vessels which are difficult to tackle surgically
· Off Pump Coronary Artery Bypass (OPCAB) or Beating Heart Bypass Surgery is a safe and proven option for bypass surgery in elderly patients
3rd September, Mohali: Elderly patients, compared with patients of a younger age group, present for surgery with a greater burden of risk factors and reduced functional levels. Short‐term outcomes are hence poorer in them. But symptomatic relief occurs in most patients and is accompanied by excellent rates of long‐term survival and a good quality of life when treated with beating heart surgery. Max super speciality Hospital Mohali recently treated an 84 year old male, Ramnarayan, who had his all three major heart arteries critically blocked. Along with this complication, the major arteries going to his brain were also blocked on both sides by 90% and 60%. The main artery on the left side of the heart (called left main ) was having 90% stenosis- in such critical conditions, bypass surgery becomes an urgent requirement. Also other three arteries, two on the left and one on right side were also blocked by 90% and 99%.
“He was very symptomatic” avers Dr Virendar Sarwal, Principal Consultant and Chief of Cardiac Surgery, his treating physician “Ramanarayan was offered high risk bypass surgery on beating heart at the time of angiography because of his age. In octogenarians, the risk to life becomes very high as all organs of the body are aging due to wear and tear. Reserves are substantially low which make it difficult for the body to undertake the stress of surgery.”
Ramnarayan decided to take some time off and went home but had to get readmitted twice in the next 10 days because of severe heart symptoms. The family accepted the high risk involved and the medical team collectively decided to work him up for surgery. “For this category of patients beating heart surgery which is now an established technique serves as very good option . But, an individualized risk–benefit profile must be carefully constructed by clinicians, taking into account several different factors and not just age alone.
On investigations, it was found that Ramnarayan’s both carotid arteries (supplying blood to the brain) were also critically blocked and we had to take extra care to avoid brain damage during surgery especially because of acute blood pressure variations. His CT scan had dilated lateral ventricles and cerebral atrophy. As there was no evidence of any major stroke we decided to go ahead with beating heart bypass by taking special precautions in the OT. Three grafts were given to him on beating heart by using octopus stabilizer and maintained higher blood pressure intra operatively.”
Ramnarayan was fully mobilized on 3rd day and discharged from the hospital on 5th day.
Discussing the advantages of off pump coronary artery bypass (OPCAB) or beating heart Bypass surgery as it is commonly called, Dr Sarwal said “ OPCAB is though technically demanding is a safe and prove option for high risk bypass surgery. Doing surgery on a beating heart eliminates the need for heart lung machine, results in fewer side effects. Some potential benefits of beating heart surgery are lower risk of stroke, fewer problems with memory loss and thinking skills, reduced injury to the heart, fewer heart rhythm problems and shorter hospital stay, less ICU stay and less usager of blood. Long term success of OPCAB includes improvement or complete relief of their symptoms and being symptom-free for several years. They may recover from surgery more quickly than those who go "on pump" and they may suffer from fewer post-operative complications.”
