Complex bypass surgery saves life of 70-Year-old man with double vessel heart disease

Varanasi/ Moradabad, June 16, 2022: Doctors at BLK-Max Hospital, saved the life of ailing 70-year-old gentleman identified as a malfunction of the Deep Brain Stimulator which was in situ for correcting his Parkinson’s disease, through a complex coronary Artery bypass Grafting Surgery (CABG), commonly known as heart bypass surgery. 

The patient who had been showing himself for his regular complaints of angina on exertion, in his own country was diagnosed with coronary artery disease (CAD). In view of having a deep brain stimulator in situ, an elective coronary angioplasty was done in Left anterior descending and Left circumflex artery as there was a risk of device malfunction. Despite treatment, the patient again felt similar symptoms within three months, and he made consultation at BLK-Max Hospital. 

Detailed investigations revealed a double vessel disease with blocked heart stent and critical left main stenosis. Since the symptoms were recurring quite early, there was a dire need to immediately perform a CABG surgery, not only to save his life but also to add quality to his life. 

“Pertaining to the pre-existing comorbidities like diabetes, hypertension and the presence of deep brain stimulation device for Parkinson’s disease, posed a major challenge to take up the surgery. As the presence of DBS devices contraindicated the use of regular unipolar cautery due to the increased risk of brain injury, or a device malfunction would pose a certain risk of life. Thus this case was majorly challenging. Despite the fact that unipolar cautery is more commonly used due to its high effectiveness, but since the patient was already having a life sustaining device (DBS) and performing unipolar cautery surgery might pose a risk for DBS device failure, the team decided to perform CABG with bipolar cautery, due to unavailability of any concrete recommendation.” Said Dr Ramji Mehrotra, Principal Director & Chief - CTVS, BLK-Max Heart Centre, BLK-Max Super Speciality Hospital, New Delhi.

Before the surgery, the team of doctors also tried to contact the device manufacturers and end-users for the literature, to find out any safe way to use unipolar cautery or harmonic, which is usually used in cardiac surgeries. 

“As a preparatory measure, the DBS was switched off, the skin incision, sternotomy and internal mammary harvest was performed with use of bipolar cautery, taking care of coagulating the punctate bleeders. The Deep Brain stimulator was switched back on after the procedure. In future we expect many more cases like this who have either DBS or any other device precluding the use of regular cautery. The skill set acquisition to be able to perform cardiac surgery with bipolar cautery will stand in good stead in these cases.” He added.