In a rare feat a multidisciplinary team at Sahyadri Hospitals, Deccan conducted three surgeries Aortic valve replacement (AVR), followed by Bypass surgery (CABG), followed by living donor Liver transplant on same day in the same setting under single anesthesia.
Patient was diagnosed with chronic liver disease, liver cancer and coronary artery disease
The procedures were conducted on a 48-year-old male patient diagnosed with several complications including decompensated chronic liver disease, liver cancer and coronary artery disease. This is one of the very rare cases in the world where all these three procedures were conducted simultaneously.
Here's how the doctors worked on the case
Explaining the case Dr Bipin Vibhute, Director and Head of Organ Transplantation & Hepatobiliary Surgery, Sahyadri Hospitals, said, "The patient came to us in the month of October 2022. He presented to us with decompensated chronic liver disease, secondary to HCV infection. He had ascites requiring tapping, GI bleed (ascites are fluids that are leaked in the belly due to increased pressure, this can cause blood vessels to swell and burst, resulting in bleeding). While evaluating him further with PET scan we found that he also has liver cancer, for which only best treatment option was early Liver transplant." "When we started him evaluating for Transplant, he was also diagnosed to have significant aortic valve stenosis and Coronary artery disease, posing severe risk for any kind of surgery, let alone transplant surgery," Dr Vibhute added.
Cardiologist Dr. Suhas Hardas, opines that the patient had conginental stenosis of aortic valve. He therefore had to be evaluated before the transplant as any heart abnormalities pose a risk for transplant. An Echocardiography is a standard measurement of evaluating aortic valve. The test conducted pointed out to a condition called Aortic valve regurgitation that occurs when one's heart's aortic valve doesn't close tightly. As a result, some of the blood pumped out of the heart's main pumping chamber (left ventricle) leaks backward. This reduces or blocks blood flow from the heart to the aorta and to the rest of the body.
The condition made it necessary to undergo heart valve replacement before the transplant.
Consultant cardiothoracic surgeon Dr. Sandeep Tadas mentioned that the patient had coronary artery disease and was advised angiography. There was 75% blockage in the right coronary artery.
Dr Vibhute added that one of the options was to get aortic valve replacement and bypass surgery done first with high risk, and then to wait for 6-12 weeks and then proceed for transplant. While there was a high risk in the first scheduled procedures, the bigger risk was the waiting time for liver transplant as the growth of the liver tumour would make it inoperable. We had a multi-disciplinary meeting (MDT) with cardiac surgery team, where we came up with another approach. We decided to perform all 3 surgeries in single setting! Aortic valve replacement, followed by Bypass surgery, followed by living donor Liver transplant on the same day, under same anaesthesia.
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