Case: Patient presented with critically blocked and calcified heart vessels which are difficult to tackle surgically
Solution: Off Pump Coronary Artery Bypass (OPCAB) or Beating Heart Bypass Surgery is a safe and proven option for bypass surgery in elderly patients
Max Super Speciality Hospital, Mohali recently treated an 84-year-old man, whose all three major heart arteries were more than 90 percent blocked. Along with this complication, the arteries going to his brain were also blocked on both sides.
Dr Virendar Sarwal, Director and Head, Cardiothoracic and Vascular Surgery at Max Super Speciality Hospital, Mohali his treating physician shared, “When the patient approached us at the hospital, his condition was very critical and in such a situation bypass surgery becomes a need of the hour. After discussion with the family members, he was taken for bypass surgery on beating heart. It has been observed that with elderly patients, the risk of undergoing an open heart surgery is very high as all organs of the body are ageing due to wear and tear, which also makes it difficult for the body to undertake the stress of surgery.
But with technological advancements in the field of medicine, beating heart surgery is now an established technique in the field of Cardiac Surgery and is also an ideal option for elderly patients. However, at our end, we - the clinicians, always weigh the surgery’s risks and benefits for the patient by taking into account several health factors and not just age alone.”
On investigations, it was found that the patient’s both carotid arteries (arteries supplying blood to the brain) were critically blocked. Dr Sarwal along with his team of operating surgeons took extra care to avoid brain damage during surgery especially because of acute blood pressure variations. His CT scan showed dilated lateral ventricles and loss of brain cells (Cerebral Atrophy). As there was no evidence of any major stroke, the team decided to go ahead with beating heart bypass while taking special precautions in the OT. Three grafts were given to him on beating heart by using octopus stabiliser (a special suction based gadget to stabilise the local area of the heart where graft has to be put on beating heart and rest of the heart keeps on beating) and maintained higher blood pressure intra operatively. Post-surgery, the patient was fully mobilised and discharged from the hospital within 5 days.
Discussing the advantages of beating heart bypass surgery, Dr Sarwal said “The beating heart bypass surgery is a safe and proven option for conventional bypass surgery in elderly patients. Doing surgery on a beating heart eliminates the need for heart lung machine which results in fewer side effects. Some potential benefits of beating heart surgery are a 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. The surgery allows improvement or complete relief of the symptoms and being symptom-free for several years. The patients may recover from surgery more quickly than those who go "on pump" and they may suffer from fewer postoperative complications.”
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.