MGM Healthcare, Chennai today showcased a successful and a rare and a complex surgery performing a living liver donor transplantation and a beating-heart bypass surgery on a 61-year-old male from Nellore in a single sitting. The dual surgery spanning over 18 hours witnessed 15 doctors from various disciplines achieving the feat with precision.
Dr Thiagarajan Srinivasan and Dr Kailash A Jain who headed the multidisciplinary team of doctors at MGM Healthcare said, “There were multiple challenges in pulling of this extraordinary feat in the form of massive blood loss during and after surgery, high risk for heart attack and arrhythmias during and after surgery, post-operative management of blood clotting. However, to save Mr Ashok it would be virtually impossible either to have a liver transplant alone or heart surgery alone as the risk was very high. He enumerated that multiple meetings of all the team members were held before surgery so that the coordination was perfect like coordinated action formula 1 car pit stop crew and virtual combined surgical plan was rehearsed before doing the actual surgery. Now six months after the surgery the patient is doing well. He further said the facilities and resources required for performing two major surgeries together are not commonly available even in best of centres and can only be performed in advanced centres where both liver and heart specialties are well developed.”
61-year-old Ashok Rao had developed severe multiple heart vessel blocks. He approached the doctors at MGM Healthcare Chennai and cardiologists advised him heart bypass surgery as the extensive disease cannot be managed by cardiac stents alone. During the evaluation by the doctors, he had a pre-existing end stage liver disease, which prevented him from having major open-heart surgery as risks of severe liver failure and mortality are very high.
The multidisciplinary team of Dr Thiagarajan Srinivasan, Director Institute of Liver Transplant and HPB surgery and Dr Kailash A Jain, Senior Consultant & Clinical Lead Cardiothoracic Surgery, along with a team of experts comprising of Dr Vivekan, senior cardiologist, Dr Arul Prakash, Lead hepatologist, Dr Dinesh Babu, Dr Nivash Chandrasekaran and Dr Shapna Varma Lead Cardiac Anaesthetists and intensivists, Dr Karthik Mathivanan, Associate director, liver transplant and 15 other specialists performed the successful dual surgeries.
Dr Kailash A Jain, Senior Consultant & Clinical Lead Cardiothoracic Surgery, Cardiac surgery in his address said, the patient’s medical evaluation showed Triple Vessel Coronary Artery Disease and a Decompensated Liver Disease for which a coronary artery by-pass and Liver Transplant Surgery was suggested.
“Doing both the surgeries in the same sitting was decided in discussion with the multi-disciplinary team, as doing one surgery alone increases the risk and worsening of function of the other organ,” he added.
Dr Karthik Mathivanan, Senior Consultant & Associate Director, Institute of Liver Transplant & HPB Surgery said the prevalence of moderate to severe coronary artery disease (CAD) in liver cirrhosis is about 26% to 30% and carries a high mortality. Candidates who are not amenable to medical management or stenting do not stand a chance to live without this sequential high risk combined procedure. Due to the complexity and high mortality of such procedures only very few centres in the world do take up such a high risk task and are able to accomplish with success. Non alcoholic fatty liver disease (NAFLD) in diabetic and obese patients is the so called “metabolic syndrome “ the prevalence of CAD is almost 50%. All liver disease patients whether candidates for Liver transplant or not, should get periodic cardiac assessment as the mortality rate is very high if cardiac disease co-exists. Early intervention can decrease mortality and morbidity.
He also stressed that patients with combined heart and liver ailments can be successfully managed by combined liver transplant and heart surgery to have a long life rather than undergoing medical management for individual ailments, which is often unsuccessful.
Lead Hepatologist Dr Arul Prakash said “End-stage liver disease leads to a number of complications and blood loss is often high; Postoperative decompensation of liver cirrhosis and causes continuous production and outflow of pleural fluid, which can lead to slow wound recovery and other immune deficiencies. But the team successfully managed to perform the combined heart bypass and liver transplant with careful planning and coordination.”
Lead Anaesthetists Dr Dinesh and Dr Nivash said, “Anaesthesia risks are high whether in individual liver or heart surgery or combined heart and liver surgery. But having a carefully coordinated plan with innovative solutions for complex problems and optimising the patient well before and during surgery has helped in the successful outcome.”
Harish Manian, CEO MGM Healthcare said, “Performing a complex procedure such as this combined liver transplant and coronary bypass graft requires great deal of expertise coupled with excellent hospital infrastructure. These kinds of successful outcomes through multi-disciplinary approach opens the door for many more critical patients who can get treated successfully and lead a normal life.”