A medical milestone

A hospital in Chennai performs a combination of complex cardiovascular surgical procedures, for the first time in the world.

CHENNAI reached another medical milestone on October 31, when a team of surgeons led by Dr. V.V. Bashi, chairperson, Centre for Thoracic and Cardio-Vascular Care at the Madras Institute of Orthopaedics and Traumatology (MIOT), performed, for the first time in the world, five bypass surgical procedures without stopping the heart, followed by an aneurysm graft using a heart-lung machine.

After the eight-hour operation, 67-year-old S.Varadharajan, the patient breathed normally and moved about his hospital room like a child who has just learned to walk. Varadharajan, who retired from Binny Mills as a supervisor, said: "I feel like I have just been born," obviously glad to be rid of the trauma and pain of a 90 per cent block in the left main coronary artery and a large aneurysm (an abnormal enlargement or bulging of an artery, caused by a damaged vessel wall) of the arch and descending aorta that had virtually left him bedridden. .

Equally happy and proud was Dr. Bashi who, after scanning the Internet for weeks, was sure that such a "complex and difficult surgery" had not been performed anywhere in the world. He said: "Performing five bypasses and surgically removing a large aneurysm using a heart-lung machine and replacing it with a graft is not new. Only it had a fatality rate of 30 to 40 per cent. What is unique about this surgical procedure is that it is relatively less risky as the heart-lung machine was used and the heart stopped only for a short time, when dealing with the aneurysm. This reduced the risk of complications to a large extent."

If Varadharajan was to survive, both surgical procedures had to be performed simultaneously. Bashi's main concern was to make the surgery as safe as possible and, at the same time, try and improve the quality of life for the patient. But the dilemma was which one of the surgical procedure had to be performed first - if the aneurysm correction was done first, Varadharajan's heart, which was pumping blood at less than 10 per cent its capacity, could stop; and if the bypasses were done first using the heart-lung machine, there was the risk of the aneurysm bursting and the patient dying almost instantaneously.

This problem kept the surgeons from operating upon Varadharajan. For them, the tricky question was whether to let Varadharajan die without surgery or endanger his life by performing the complicated procedure.

Finally Dr. Bashi decided to go ahead with both the procedures, but only after conducting extensive research, by sifting through medical literature, browsing the Internet and speaking to experts across the world. On October 31, after a battery of tests, the team performed the eight-hour-long high-risk surgical procedures.

First, the five bypass procedures were performed without stopping the heart. The procedures, which lasted over two hours, improved the patient's heart's pumping capacity remarkably. Then the patient was connected to a heart-lung machine. His body (and blood) temperature was lowered to 15C. Blood supply to the brain, heart, kidney, liver and stomach was stopped.

According to Dr. Bashi said: "This part of the surgery was the most difficult as it had to be completed in 30 minutes as otherwise the patient could die with no blood supply to the vital organs. We noticed that his aorta was like an inflated balloon. It could have burst any moment. But the bypass had improved the condition with many blood-starved regions of the heart receiving good supply."

The aneurysm was opened and the whole of the arch and descending aorta was replaced with a tube graft within the stipulated time. The blood vessels going to the brain and the spinal chord were then attached to this graft. Blood circulation was restored and the blood warmed to 37C. As soon as blood started flowing to all vital organs and the body began to function normally, the patient was disconnected from the heart-lung machine. After two weeks of post-operative care in the hospital, Varadharajan is now near normal.

Dr. Bashi said: "Skill alone is not sufficient to perform such a difficult and complex surgery. The infrastructure is also important." Apart from physical infrastructure, MIOT is in the process of working out insurance schemes for heart operations. The total cost for Varadharajan amounted to Rs.2.5 lakhs. But, according to Dr. P.V.A. Mohandas, managing director, MIOT, the operation need not be so expensive. "MIOT is planning an insurance scheme by which the hospital will take permanent care of the heart for a nominal sum every year over a stipulated period." The details, Dr. Mohandas said, were being worked out.