Surgery conducted without ECMO Support using a Special Operative Technique

Patient removed from ventilator support within two hours after completion of the surgery

Bengaluru : In a rare heart surgery, doctors at Specialist Hospital in Bengaluru repaired a ruptured heart wall of a 57 year old male patient. The patient was rushed to the hospital after suffering a massive heart attack at home. He was brought in in an unconscious state, his blood pressure was not measurable and his pulse was very mild. He was put on an endotracheal tube for oxygen supply directly to the lungs and had only 0.1 per cent chance of survival. Mahadev Rao had suffered a left ventricular rupture, a condition which has a survival rate of less than 5 per cent. Clinically, a ventricular rupture is the tearing of the wall of the ventricles of the heart, which occurs mostly after an acute myocardial infarction or heart attack. Most patients who suffer ventricular rupture are diagnosed only post mortem. Medical intervention at the appropriate time by an interprofessional team at Specialist Hospital including Dr. Tameem Ahmed – Chief Cardiothoracic Surgeon, Dr. Amit Lal – Anesthetist, Dr. Suresh – Cardiac Surgeon, Dr. Vikas Keshri – Cardiac Surgeon, Dr. Mahadev Swamy – Cardiologist, Dr Bhargav Intensivist, Mr. John – Senior Perfusionist and Mr. Vivek – Surgical Assistant saved the life of Mahadev Rao.

“When the patient came to the hospital, we conducted an ECG and ECHO and found there was fluid collection around his heart, which was caused by the rupture of the left ventricle of the heart. The patient’s PH value was 6.7 when compared to the normal value of 7.4 which makes it difficult for the normal working of the heart and body and his heart wall was ruptured outside the pericardium resulting in pericardial tamponade or filling of the sac outside the heart with fluid, which prevents the heart’s ventricles from expanding fully and functioning properly. We had to fight against time to shift him straight to the operation theatre for immediate surgery in order to give him any chance of survival” said Dr. Tameem Ahmed, Chief Cardiothoracic Surgeon, Specialist Hospital.

Doctors opted to go ahead with surgery directly rather than to put the patient on an Extracorporeal membrane oxygenation (ECMO) life support machine as the surgery had to be conducted at the earliest. The patient was on auto-transfusion (blood was re-routed from the heart into the vein for circulation) and shifted directly to the operation theatre without ECMO support.

“The pressure on the team of doctors was enormous, given that survival rate was less than one percent and the high possibility of an on-table-death. We however took the case as a challenge and prepared the patient for surgery, shifted the patient to the operation theatre within a few minutes and immediately hooked him on to a heart lung machine and from then on things changed for the better for the patient. We had to use a special operative technique where under running sutures had to be taken below two main arteries of the heart in order not to compromise those two main arteries. On successful completion of the surgery, we extubated the patient and removed him from ventilator support within two hours of completing the surgery.” Dr. Tameem added.

“My father complained of severe chest pain and collapsed at home on 30th December 2021 and we had to rush him to the hospital. On reaching the hospital we were told that his survival rate was 0.1 percent, even if a surgery was conducted on him. However, encouraged by the enthusiasm and confidence of the chief surgeon, we opted for the surgery. We are happy that the whole episode which started off as a severe ordeal for my family ended in immense satisfaction and joy for us, as we walked out of the hospital along with our father out of the hospital on 7th January 2022” said Mahima, daughter of patient name who is incidentally pursuing her MBBS.

Mahadev Rao is recuperating well and is well on his way to a complete recovery.