Wockhardt Hospitals Blog

A complicated beating heart surgery was performed by the cardiac team at Wockhardt Hospitals.Mulund,Mumbai on a 59 year old patient without blood transfusion. Mr. Kabilar a resident of Kalyan had successfully undergone an emergency beating heart bypass graft surgery without receiving a single drop of transfused blood. The surgery was performed by Dr. Ajay Chaugale, Consultant Cardiovascular Surgeon, Wockhardt Hospitals and his team.

Mr. Kabilar was suffering from a coronary artery disease, leaving his heart with a capacity to pump blood only up to 20 percent ejection fraction. In addition to this, he was a diabetic (type II) and suffered low weight. His hemoglobin count was a discouraging 8.5 gm/dL as against the standard count of 13-15 gm. “The patient was required to undergo Coronary Artery Bypass Graft (CABG) procedure to enhance the blood pumping ability of the heart. The patient was ready to check options available for treatment, but was firm about not accepting blood, however much the quantity,” explains Dr. Ajay Chaughule, Cardiovascular Surgeon, Wockhardt Hospitals addressing the press meet.

The fact that Mr. Kabilar is a member of Jehovah Witness and as per their religious belief they oppose blood transfusions made the case all the more complicated. “The case of this patient presented with several complications and serious potential risks was far more challenging to treat when compared to any other patient with similar complications,” said Dr. Bharesh Dedhia, Chief Intensivist, Wockhardt Hospitals.

Under normal circumstances doctors generally look into the possibility of conserving blood when operating and one way of blood saving procedure known as autologus blood transfusion. In this procedure, a required quantity of blood is drawn from the patient prior to the surgery. The blood is preserved and then transfused back into the person, should there be a need for it in the course of a certain surgical procedure. These procedures also aid in conserving the patient’s blood in terms of hemoglobin counts” explained Dr. Ajay Chaugale.

Being a staunch believer of his religion, the Mr. Kabilar was not even ready for an autologus blood transfusion. So the next option the doctors suggested to him was `Cell Saver’ technique. In this procedure the blood that is lost during the surgery can be sucked and purified in order to extract the patient’s RBC that can be given back to the patient.

“The Cell Saver technique could have been a good option to consider for the patient’s CABG (Coronary Artery Bypass Graft) procedure, but what came in the way this time around was the high cost. The technique did not seem financially viable for the patient. The challenges to get everything working in his favour were many” said Dr. Ajay Chaugle.

The next best alternative was to put the patient under therapeutic agents (hematenics) to increase hemoglobin concentration and to enhance the overall quality of the patient’s blood. According to Dr. Ajay Chaugle “We put the patient on hematenics for about a month and the results were quite encouraging, his hemoglobin count jumped from 8.5 gm/dL to 11 gm/dL within a month.”

With his hemoglobin counts encouraging, doctors decided to go ahead with a beating heart surgery for Coronary Artery Bypass Graft (CABG). As the name suggests, the surgery is performed without stopping the heart. A special device stabilizes the part of the heart that gets being operated upon. In beating heart surgeries, blood circulation to the heart muscles is not modified. Predictably, the risk of complications associated with temporarily stopping and restarting the heart function and the complicated arising from blood flowing through (fusion )

The biggest advantage of Beating Heart CABG are

The more common conventional CABG surgery is performed on a stopped heart. The heart is temporarily made to stop beating by administering a special solution – cardioplegia – every 25 minutes during the surgery. The functions of the heart and the lungs are isolated with a Cardio Pulmonary Bypass Machine (heart-lung machine). With the blood flowing to the oxygenator through this machine comprising several tubes, the blood cells may be subjected to some wear and tear. Complications can arise following injury to the blood cells.

But all that and more was shelved in the case of this patient and more importantly, accomplished without blood transfusion despite complications in the patient. The three-hour Beating Heart CABG was performed successfully and the patient was discharged after 3rd post operative day. “Surgeries on members of the Jehovah Witness community have been performed in the past, but it was the complication and the risk associated with this patient that made this case a rare one,” says Dr. Ajay Chaughule.

Mumbai, April 11, 2009: The liver unit team at Wockhardt Hospitals performed a life saving liver resection on an eighteen month old baby giving her a fresh lease of life. The team led by Dr. S K Mathur, Senior Consultant Surgeon, HPB Surgery & Liver Transplantation; Wockhardt Hospitals successfully completed the four hour surgery on this little baby without any complications.

The one-and-a-half year old baby a native of Orissa was diagnosed with hepatoblastoma, a rare cancerous tumour that originates in the liver. To worsen matters, it was detected at a rather locally advanced stage complicating matters for the ailing child. After undergoing chemotherapy at another Mumbai hospital she was to Wockhardt Hospitals for further intervention.

“The chemotherapy that Sumana had taken served to downsize the tumour in her liver to make it more resectable.” says Dr S K Mathur, Senior Consultant Surgeon, HPB Surgery & Liver Transplantation, Wockhardt Hospitals. “But it was the late detection that had worsened Sumana’s case. Cases of liver tumors in such young children are very rare almost one in a million. Managing such a small baby for a major liver resection was quite a difficult task and such surgeries are not commonly done on them.”

If eighteen-month old Sumana could just spell it out, she would have agreed heartedly and thanked Dr S K Mathur and Dr. Mahesh Goel and Wockhardt Hospitals for giving her a new life.

Dr. Mahesh Goel, Consultant Onco Surgeon at Wockhardt Hospitals said “This is a rare tumor potentially curable if treated at the right time and requires highly technical skill set to perform such a surgery. The challenge lies in removing the diseased part of the live safely in such a small child without any complication, no loss of blood and with adequate margin of liver to achieve cure.”

Dr. Mathur also added, “Sumana stayed in the ICU for one day, oral feeds started on the first day and she was discharged on the fifth day. The cause of her cancerous liver tumour could probably have been genetic. But it is a potentially curable cancer in a child, if it is treated in the early stages. During surgery we had to take care to prevent excessive blood loss and hypothermia (abnormally low body temperature. If Sumana’s case had gone untreated, she would probably not have survived for more than six months.”

Dr. Sangeeta Shetty, Consultant Anesthetist, Wockhardt Hospitals said, “The hospital provides technical backup during surgery of such a young patient. Intra operative care is taken during anesthetic management of such a small baby which includes maintaining temperature, physiological status, intravenous fluid and ensuring this is continued in the post operative period.”

Also present at the occasion Dr. Ravindra Karanjekar, Associate VP, Wockhardt Hospitals Mumbai said, “Wockhardt hospitals Mulund has developed expertise in Hepato billiary Surgeries including Liver transplant. With the help of Harvard International we have set up a well developed Transplant program in the country and have successfully conducted few liver transplants in the city. Such complex surgeries are not possible without highly skilled surgeons like Dr. Mathur & Dr. Goyal and require a great team work of anesthetists, nurses & other paramedical staff. Intensivists also play a vital role in such surgeries. Surgeries as such are very critical & Wockhardt Hospital is always on the forefront to bring in newer medical services to western region of the country. Our motto is save lives at any cost!”


About Hepatoblastoma

Hepatoblastoma is a very rare cancerous tumour that originates in the liver, which is one of the largest organs in the body. The primary functions of the liver include filtering and storing blood. The liver consists of left and right lobes, and it is commonly seen that most hepatoblastoma tumors generally occur in the right lobe. This disease primarily affects children from infancy to about five years of age. Most cases show up during the first 18 months of life. Hepatoblastoma cancer cells are known to metastasize or spread to other areas of the body. The most common sites of such metastasis are the lungs, into the abdomen, and in some rare cases to the central nervous system, bone and bone marrow.


About Department of Gastro-intestinal & HPB Surgery Wockhardt Hospitals: