Fortis Escorts Heart Institute (FEHI) successfully performed a double surgery to correct a left ventricle aneurysm followed by an left ventricular assisting device (LVAD) implant. This is a unique achievement because it is the first ever recorded case in India of a patient of this age undergoing a procedure of such dual complexity.

Dr T S Kler, executive director, Cardiac Sciences, FEHI along with the surgical team led by Dr Z S Meharwal, director, Department of Cardiovascular Surgery and Dr Vishal Rastogi, director, Heart Failure Clinic extended their support in management of the 74 year old, patient, Sardar Amrik Singh's heart functions, who had suffered large anterior wall myocardial infarction (heart attack). He was having recurrent episodes of breathlessness on mild exertion, a classic feature of heart failure.

After consulting several hospitals, he was turned away and was told that there were no options for his condition except a heart transplant. As a rule, heart transplants are not performed on patients beyond the age of 60 years. Heart transplant also has a major limitation of donor availability. The Patient is making good recovery with improvement in his heart, kidney and liver function in addition to an enhanced nutrition status.

When the patient visited Dr Kler, his coronary angiography revealed a 100% blockage of one coronary artery identified as the cause of major heart attack. Echocardiography revealed a very low heart function with a large left ventricle aneurysm. The Patient was diagnosed to be in end-stage heart failure, due to ischemic cardiomyopathy and had features of organ dysfunction, including that of the kidney and the liver.

Honored with Padma Bhushan by President of India, Dr T S Kler is a pioneer in cardiac electrophysiology in India. He was the one to implant the first ICD (device to prevent sudden cardiac death) in 1995 and then a heart failure device (CRT-P) and a COMBO device (CRT-D) in India.

The patient was evaluated and stabilized by medical therapy. He continued to be in heart failure in spite of the best medical therapy. A decision to do a LVAD implant was taken. Since the patient had a Left Ventricle aneurysm, it posed a high challenge. The doctors had to first repair the Aneurysm. The thin and dilated part was excised and repaired. After this procedure the LVAD was implanted.

The LVAD is a kind of mechanical heart which is placed inside a patient’s chest where it helps the heart to pump oxygen-rich blood throughout the body. As opposed to an artificial heart, the LVAD does not replace the heart, but it helps it do its job. One end hooks up to the left ventricle, the chamber of the heart that pumps blood out of the lungs and into the body. The other end hooks up to the aorta, the body's main artery. A tube passes from the device through the skin. This is known as the ‘drive line’ and it comes out of the body through the abdominal skin and connects the pump to the controller outside which is used for charging the batteries. The outside of the tube is covered with a special material to aid healing and allow the skin to regrow.  

An LVAD restores normal blood flow to a person whose heart has been weakened by heart disease. This relieves symptoms such as being constantly tired or short of breath, weakness and swelling of the body. And sometimes it lets the heart recover normal function by giving it a chance to rest.

Dr Meharwal, director, Department of Cardiovascular Surgery, Fortis Escorts Heart Institute said, “The age of the patient, the left ventricle aneurysm, the condition of the heart and whether the patient will be strong enough to withstand the procedure and the care post the surgeries were all the concerns that posed a big challenge for us. After eliminating what could not have been performed, we opted for the LVAD planning it after the aneurysm was treated.”

Dr Vishal Rastogi, director, Heart Failure Clinic said, “The patient has to be managed on certain parameters to ensure continued good health. The patient required supportive therapy in the post-operative period because of kidney and liver dysfunction. All the restrictions like diet, exercise have to be monitored regularly and this is done by the team at the Heart Failure Clinic in the hospital and with cooperation from the family members after the patient is discharged.”

Padma Bhushan Awardee Dr Ashok Seth, chairman, FEHI, said, “It is indeed a proud moment for us to have achieved this dual clinical milestone. We have in the past broken multiple records such as Open heart surgery on an 18 hour baby; first sub-cutaneous ICD implant; heart surgery on a 102 year old; second pacemaker implant in a two-time cancer survivor through an unconventional route and many more milestones. The skills and expertise of the teams of doctors are globally recognized. We will continue to break many more records in our endeavor to provide better cardiac solutions to our patients.”