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 patient’s 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 patient’s 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. Gany’s 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”.