Wockhardt Hospitals performs a complicated Beating Heart Surgery without Blood Transfusion

~Faith by His Side, This Case Challenged Medical Excellence~

A complicated beating heart surgery was performed by the cardiac team at Wockhardt Hospitals.Mulund,Mumbai on a 59 year old patient without blood transfusion. Mr. Kabilar a resident of Kalyan had successfully undergone an emergency beating heart bypass graft surgery without receiving a single drop of transfused blood. The surgery was performed by Dr. Ajay Chaugale, Consultant Cardiovascular Surgeon, Wockhardt Hospitals and his team.

Mr. Kabilar was suffering from a coronary artery disease, leaving his heart with a capacity to pump blood only up to 20 percent ejection fraction. In addition to this, he was a diabetic (type II) and suffered low weight. His hemoglobin count was a discouraging 8.5 gm/dL as against the standard count of 13-15 gm. “The patient was required to undergo Coronary Artery Bypass Graft (CABG) procedure to enhance the blood pumping ability of the heart. The patient was ready to check options available for treatment, but was firm about not accepting blood, however much the quantity,” explains Dr. Ajay Chaughule, Cardiovascular Surgeon, Wockhardt Hospitals addressing the press meet.

The fact that Mr. Kabilar is a member of Jehovah Witness and as per their religious belief they oppose blood transfusions made the case all the more complicated. “The case of this patient presented with several complications and serious potential risks was far more challenging to treat when compared to any other patient with similar complications,” said Dr. Bharesh Dedhia, Chief Intensivist, Wockhardt Hospitals.

Under normal circumstances doctors generally look into the possibility of conserving blood when operating and one way of blood saving procedure known as autologus blood transfusion. In this procedure, a required quantity of blood is drawn from the patient prior to the surgery. The blood is preserved and then transfused back into the person, should there be a need for it in the course of a certain surgical procedure. These procedures also aid in conserving the patient’s blood in terms of hemoglobin counts” explained Dr. Ajay Chaugale.

Being a staunch believer of his religion, the Mr. Kabilar was not even ready for an autologus blood transfusion. So the next option the doctors suggested to him was `Cell Saver’ technique. In this procedure the blood that is lost during the surgery can be sucked and purified in order to extract the patient’s RBC that can be given back to the patient.

“The Cell Saver technique could have been a good option to consider for the patient’s CABG (Coronary Artery Bypass Graft) procedure, but what came in the way this time around was the high cost. The technique did not seem financially viable for the patient. The challenges to get everything working in his favour were many” said Dr. Ajay Chaugle.

The next best alternative was to put the patient under therapeutic agents (hematenics) to increase hemoglobin concentration and to enhance the overall quality of the patient’s blood. According to Dr. Ajay Chaugle “We put the patient on hematenics for about a month and the results were quite encouraging, his hemoglobin count jumped from 8.5 gm/dL to 11 gm/dL within a month.”

With his hemoglobin counts encouraging, doctors decided to go ahead with a beating heart surgery for Coronary Artery Bypass Graft (CABG). As the name suggests, the surgery is performed without stopping the heart. A special device stabilizes the part of the heart that gets being operated upon. In beating heart surgeries, blood circulation to the heart muscles is not modified. Predictably, the risk of complications associated with temporarily stopping and restarting the heart function and the complicated arising from blood flowing through (fusion )

The biggest advantage of Beating Heart CABG are

• No wear and tear of blood components, and

• Less chances of further complication.

The more common conventional CABG surgery is performed on a stopped heart. The heart is temporarily made to stop beating by administering a special solution – cardioplegia – every 25 minutes during the surgery. The functions of the heart and the lungs are isolated with a Cardio Pulmonary Bypass Machine (heart-lung machine). With the blood flowing to the oxygenator through this machine comprising several tubes, the blood cells may be subjected to some wear and tear. Complications can arise following injury to the blood cells.

But all that and more was shelved in the case of this patient and more importantly, accomplished without blood transfusion despite complications in the patient. The three-hour Beating Heart CABG was performed successfully and the patient was discharged after 3rd post operative day. “Surgeries on members of the Jehovah Witness community have been performed in the past, but it was the complication and the risk associated with this patient that made this case a rare one,” says Dr. Ajay Chaughule.