Minimally Invasive Heart Surgery At Global Health City Not Only

Mended His Heart Valve, But Also Ensured A Successful Liver

Transplant
In a first-of-its-kind procedure in India, a 45-year old gentleman with end stage liver failure
underwent a minimally invasive heart valve surgery to enable being operated for liver
transplantation successfully
Chennai, 18th March 2015: Needless to say about the importance of liver transplantation for a
person with end stage liver failure. The story of this 45-year old gentle man was different and
challenging. His heart had to be mended first so that he could undergo liver transplantation. Today,
he is a live example of how a hopeful heart can offer hope to other vital organs.
Mr. Abdulla was suffering from severe end stage cirrhosis was referred for liver transplantation to
Global Health City. Upon presentation, he was found to have sepsis and managed in ICU. Following
the recovery from sepsis he underwent evaluation for liver transplantation. As a routine work-up for
liver transplantation, he underwent a thorough cardiac assessment. During the cardiac evaluation he
was diagnosed to have severe Tricuspid valve regurgitation (blood to flow backward (leak) into the
right upper heart chamber (atrium)).
Dr. Dinesh Jothimani Senior Liver Transplant Physician at Global Health City said Presence
of severe Tricuspid valve regurgitation would preclude him from having a liver transplantation,
because the graft will get congested and damaged due to back flow of blood from the heart.
Therefore it was important to sort out the heart problem prior to liver transplantation. However, he
will not tolerate a major heart surgery, as his liver will fail completely, leading to severe morbidity
and mortality. Post discussion with our cardiac surgical team, we decided to perform Minimally
Invasive Cardiac Surgery (MICS).
Dr. M. M. Yusuf - Senior Consultant Minimally Invasive Cardiac Surgeon at Global Health City
said Performing cardiac surgery in patients with end stage liver failure carries much higher risk. In
case of Mr. Abdulla Cardiopulmonary (Heart-Lung) Bypass (CPB) machine had to be used to
perform valve repair. Prolonged use of CPB machine during cardiac surgery may lead to ischemic
liver damage and irrevocable liver failure. Subsequent bleeding could lead to death of the patient. In
addition, the cardiac surgery had its inherent complications. In traditional open heart surgery sternum
splitting is the major source of bleeding, infection and cause of delayed recovery. In view of the
above, a Minimally Invasive Approach to repair the valve was considered to be the best option.
Thus, it reduces the tissue damage and the risk of bleeding, and preserves the patients original
valve.
After having a detailed discussion with the liver team, Mr. Abdulla was taken to operation theatre
and an Endoscopic Port access Tricuspid Valve Repair surgery was performed. A 7-cms incision and
a 5-cms incision were made on the right mid chest and the right upper thigh fold respectively. While
through the former incision the valve was repaired, the latter incision was used to access the leg
blood vessels to place the patient on heart-lung bypass machine. Post the procedure, he had Very
minimal bleeding due to inherent advantages of minimally invasive approach. His recovery time was
extremely quick and was discharged 5-days after the surgery, further added Dr. M. M. Yusuf.

Adding further on the occasion, Dr. Dinesh Jothimani mentioned that After about 4-weeks time,
Mr. Abdulla was admitted to the hospital for liver transplantation. The team spearheaded by Prof.
Mohamed Rela performed the liver transplantation surgery and now he is recovering. He is the
living example who offers hope to showcase how a team of highly skilled experts can transform a
sick patients life.
Yet another patient, Mr. Mohammed Gany, a 52 years old gentleman during his evaluation for liver
transplantation, he was found to have severe coronary artery disease (triple vessel) which would have
precluded him from liver transplantation. We had involved our cardiac team for further surgical
management added Dr. Dinesh Jothimani
Unlike the surgery on Mr. Abdulla, we performed Mr. Ganys surgery through Open heart surgery
(beating heart technique) without placing him on CPB. This helped him to recover faster and reduced
the risk of further liver damage. Post the cardiac surgery, he underwent liver transplantation
successfully and is doing well. Stated Dr. M. M. Yusuf
Dr. M. M. Yusuf concluded saying that Various medical literatures across the globe reveal that
combined procedure i.e. cardiac surgery and liver transplant performed in single-sitting produce
better results than the staged procedures, when Minimally Invasive Cardiac Surgery or Beating Heart
surgery is not possible. We are very proud that Global Health City is one of the very few centres in
the world with surgical expertise and facilities to perform such staged procedures.