64-year-old Hamsaveni, a known case of diabetes and hypertension, had previously undergone aortic valve replacement and CABG (Coronary Artery Bypass Graft) surgery ten years ago at a private hospital in the city due to a congenital valve disorder. However, recently she began experiencing giddiness, chest discomfort and breathlessness prompting her to seek medical attention at her previous hospital. There she was diagnosed with single-vessel coronary artery disease. It was revealed that the prosthetic valve implanted during her previous surgery had failed, resulting in severe re-narrowing of the blood vessel. Unfortunately, the hospital declined treatment due to the complex nature of her condition. Same was the situation with several other premium hospitals across the country.

Drowing to the delay in treatment, her condition worsened three months ago with symptoms becoming increasingly unresponsive to medication. She developed persistent and progressive heart failure, along with multi-organ dysfunction for which she was admitted at Fortis Bannerghatta. On evaluation, it was revealed that her aorta (largest artery in the body that carries blood away from the heart) was abnormally thickened and calcified (harden by the deposits of calcium). It was also abnormally twisted and tortuous. Furthermore, the previously replaced prosthetic valve was abnormally tilted to the extent that tracking a new valve would be highly challenging. Also, it posed a high risk of blocking the coronary blood vessel leading to heart attack on the operating table.

Talking about the complexity of the case, Dr Vivek Jawali, Chairman – Cardiothoracic and Vascular Sciences, Fortis Hospitals, Bengaluru, said, “This case is exceptionally rare and challenging, requiring a tailored interventional and surgical approach. We knew that this was a case where we couldn’t afford to give up. At Fortis, we are driven by our relentless pursuit of medical excellence, and this successful patient outcome is a testament to our unwavering commitment to pushing the boundaries of what is achievable in healthcare. This extraordinary case not only highlights the advanced capabilities of Fortis Hospitals but also underscores the unmatched expertise and unyielding dedication of our clinical team.”

Elaborating on the case Dr Srinivas Prasad, Senior Consultant – Interventional Cardiology at Fortis Hospital, Bannerghatta, said, “Considering the complex situation, initially we planned for a high-risk hybrid TAVR (Transcatheter Aortic Valve Replacement) procedure, which involved MIDCAB (Minimally Invasive Direct Coronary Artery Bypass) for grafting the right coronary artery (RCA) followed by TAVR. However, while inducing anaesthesia, the patient experienced a cardiac arrest and multiorgan failure, which led to a change in plans.

She was immediately shifted to the Cath lab for an emergency TAVR, wherein a catheter was passed through a blood vessel in the groin and guided to the aortic valve through the twisted aorta and tilted valve using innovative techniques. The new valve was then deployed to restore proper blood flow. The procedure was conducted successfully employing various precautionary strategies so that coronary blood flow is not compromised. She was then shifted to CCU (Cardiac Care Unit) and placed on a ventilator where the team managed the patient’s condition effectively for the next five days. Subsequently, she was discharged on the 10th day after her condition had stabilized.”

Mr Akshay Oleti, Business Head, Fortis Hospitals, Bangalore said, “We are incredibly proud to have accomplished this first of its kind medical breakthrough, demonstrating our commitment to delivering exceptional care to our patients. This groundbreaking achievement sets a new standard in the field of cardiac surgery, offering hope to patients facing even the most complex and challenging conditions. Fortis continues to lead the way in cutting-edge medical interventions, reaffirming its commitment to providing world-class healthcare and pushing the boundaries of medical science.”