Man with 12 bypass grafts ready for discharge

A cardiac patient with a fatal heart condition, which was declared "inoperable", has got a new lease of life after a complex, record-breaking surgery was performed on him by renowned Indian cardiac surgeon Ramakant Panda.

In what is being termed as a revolutionary life-saving surgery, Panda operated on 58-year-old Mithalal Dhoka to remove a staggering 17 blocks through 12 bypass grafts at the Asian Heart Institute in the northwestern Bandra suburb Feb 12. Armed with the unprecedented medical feat, the institute is planning a Guinness World Records citation.

"We did an internet search and the maximum number of bypass surgeries (on a patient) reported so far are eight. This is the first time in the world that 12 bypass grafts were done on any patient on a beating heart," Panda told IANS in an interview.

Hailing from Yadagiri in Karnataka but now based in Hyderabad, Dhoka, who was dismissed by medicos as "an inoperable case", has been suffering from diabetes and hypertension for over two decades. In early February, he suffered from severe chest pain and breathing problems for which he was rushed to Hyderabad's Krishna Institute of Medical Sciences.

A coronary angiogram revealed 17 blockages in all three major arteries.

"An additional concern was that instead of the normal three arteries in a human heart, he had more than 12 arteries that were all one mm or less in diameter. Due to his general health and diabetic condition, this problem had developed over the years," Panda said.

All the arteries were very small, and in view of the multiple blockages with high cholesterol deposits, Dhoka was considered unfit for surgery. He was brought to the institute Feb 12 and wheeled on to the operation table in a critical condition with low blood pressure and high lung pressure. An intra-aortic balloon pump was put inside the heart to support his blood pressure and circulation during surgery," Panda said.

Since the conventional technique of using a mixture of arterial graft and vein graft from the leg was not possible for so many blockages, Panda used arterial grafts in a sequential manner in all the 12 arteries with blocks.

At the end of the 11-hour-long surgery, a weary Panda stepped out of the operation theatre - unaware that he had just created a world medical record.

Post-surgery, Dhoka has shown dramatic recovery and improvement in his heart and general health condition.

"We did a CT angiogram after three weeks and all grafts were found to be working well. He underwent a stress test which was normal, proving that while he was running an equivalent of seven kilometres an hour, his heart drew its full blood supply," Panda said, adding that the patient was ready for discharge.

He said the difference between Dhoka and other cardiac patients was that the latter could have three-four blocks, but Dhoka had more than four times the normal.

Dhoka has been a diabetic for the past over 30 years.

Panda, who attained recognition after operating on Prime Minister Manmohan Singh five years ago, is now doing research on the relation between diabetes and multiple grafts in heart patients. So far, he has operated on more than 500 patients in the 20-80 year age-group, 90 percent of whom were diabetics.

Indians who are more prone to heart diseases and also diabetes, which is a risk factor for cardiac ailments, also tend to have multiple blockages, Panda said.

(Quaid Najmi can be contacted at q.najmi@ians.in)