The Cardiothoracic and Vascular Surgery (CTVS) team at Sri Ramakrishna Hospital recently performed a Minimally Invasive Cardiac Surgery (MICS) along with an aortic root enlargement procedure on an 82-year-old woman.
The procedure was carried out by a team led by Dr. Thiagarajamurthy, Chief of the CTVS Department.
According to a press release issued by the hospital, the patient, who has diabetes and hypertension, had been suffering from chest pain and breathlessness for more than a year. She sought treatment at Dr. Thiagarajamurthy’s outpatient department at the hospital.
Clinical evaluations revealed that she was suffering from severe calcific aortic stenosis, a condition in which the aortic valve becomes narrowed due to calcium deposits, restricting blood flow from the heart to the body. Considering the patient’s age and medical condition, the surgical team opted for a minimally invasive approach instead of conventional open-heart surgery.
The patient was scheduled for an upper partial sternotomy, commonly known as the “Mini-J” approach. This technique involves a small incision in the upper chest to access the heart.
During the surgery, intraoperative Transesophageal Echocardiogram (TEE) imaging and clinical assessment revealed that the patient had a small aortic annulus, the ring-like structure that supports the aortic valve.
According to the release, implanting a standard-sized prosthetic valve in a small annulus can result in post-operative complications. The surgical team therefore performed a Bo Yang aortic root enlargement procedure, which widened the base of the aorta and enabled the implantation of an appropriately sized bioprosthetic valve.
The hospital stated that performing an aortic root enlargement through a minimally invasive incision requires specialised surgical expertise.
Following the surgery, the patient was taken off ventilator support within 12 hours and was shifted from the intensive care unit to a regular ward on the second day after surgery. The hospital reported that her heart rate and blood pressure remained stable throughout the recovery period.
After post-operative evaluation, including a follow-up echocardiogram and other clinical assessments, the patient was discharged.
The hospital said that the minimally invasive approach helped reduce recovery time, minimise bleeding and lower the risk of complications associated with larger chest incisions in elderly patients.
“Operating on octogenarians always demands careful precision, but combining a minimally invasive approach with an unexpected root enlargement truly tests the boundaries of modern cardiothoracic surgery,” local medical observers noted.
The success of this complex procedure was made possible through the seamless collaboration of a multidisciplinary team. Dr. Thiagarajamurthy, Chief of the CTVS Department, supported by the Cardiac Anaesthesia team comprising Dr. Ashok Hariharan, Cardiac Anaesthesiologist, Dr. Narendran Menon, Cardiac Anaesthesiologist, and Dr. S. Manikandan, Cardiac Anaesthesiologist.
Their expertise in perioperative management, advanced monitoring, and anaesthetic care played a crucial role in ensuring the patient’s safety and contributing to the successful outcome of this rare and challenging surgery.
