15-member MGM Healthcare team performs 18-hour-long dual surgery on sexagenarian

This twin surgery was performed spanning over 18 hours with a team of 15 doctors from various disciplines achieving the feat with precision.

Dr Thiagarajan Srinivasan, Director, Institute of Liver Transplant and HPB Surgery and Dr Kailash A Jain, Senior Consultant & Clinical Lead Cardiothoracic Surgery 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 liver transplant alone or heart surgery alone as the risk was very high. The team held discussion in over 4 meetings of all the members before surgery so that the coordination was perfect like the ‘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. They 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 specialities are well developed.

• 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 specialities are well developed: Dr Thiagarajan Srinivasan, Director, Institute of Liver Transplant and HPB Surgery and Dr Kailash A Jain, Senior Consultant & Clinical Lead Cardiothoracic Surgery

Ashok Rao, 61, 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.

Following the detailed corroboration 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 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 twin surgeries.

According to Dr Kailash A Jain, 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. Non alcoholic fatty liver disease (NAFLD) in diabetic and obese patients 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.”

Patient prof Ashok, a nuclear chemist and his live donor niece were present at the presser thanked the doctors team at MGM Healthcare.