Minimally invasive cardiac surgery performed on wide-awake patient

NASHIK: City doctors have recently performed a minimally invasive bypass surgery, with the patient awake through the procedure listening to soft music on headphones. The surgery was performed on a 65-year-old cardiac patient who has now recovered.

Senior heart specialist and director of Shree Saibaba Heart Institute, Dr Aniruddha Dharmadhikari said, "65-year-old Bhagwan Bhodhade came with chest pain to our hospital. We carried out investigations and found a single major block in the left anterior descending coronary artery. Due to technical reasons, the angioplasty was not possible."

The patient was then referred to cardiac surgeon Dr Swapneel Karne who decided to perform coronary artery bypass surgery grafting through a small incision. The surgery is called Minimal Invasive Coronary Artery Surgery (MICAS) and was performed by keeping the patient awake by administering cervical epidural anaesthesia.," Dr Dharmadhikari added.

Since the patient was suffering from hypertension and abnormal kidney parameters, he was a high-risk case for general anaesthesia. So the case was referred to cardiac anaesthetist Dr Chandrashekhar Khairnar. "I decided to administer cervical epidural anaesthesia, which is given through the neck vertebrae. Due to this, only the chest area of the patient was anesthetised," he said.

Administering this type of anaesthesia requires special skills and the Cardiac Anaesthetists Forum has described it as a rare feat.

After anaesthesia was administered, Dr Swapneel Karne performed the bypass surgery through a very small 3.5 inch incision on the left side of the chest below the left nipple. "The left lung was then deliberately collapsed for maximum access to the surgical area. The patient was breathing through his right lung throughout the surgery," Dr Khairnar said.

The vital parameters like heart rate, blood pressures, oxygen levels in the blood, urine output were well controlled by the anaesthetist while the patient was awake and listening to some music. "He was also obeying the verbal commands," Dr Khairnar added.

Dr Swapneel Karne, who performed the surgery, said this was a rare achievement. "The operation was successful and the patient was allowed to drink water 30 minutes after surgery. Post-operative pain relief was given through the epidural catheter for the next 36 hours," he said. The operation was assisted by Dr Ramnath Darade and perfusionist Shreemati Kulkarni.

City-based cardiac surgeon Dr Ranjit Jagtap said the surgery was a rare one and has created a buzz in the medical fraternity.

MICAS (Non-sternotomy) cardiac surgery is less painful and insures minimal blood loss and early recovery of the patient.

The above is from ETHealthworld.com