A team of doctors at Apollo Hospitals, Hyderabad, managed to save the life of a 67-year-old patient in a complex surgery by transplanting a part of his liver and performing Coronary Artery Bypass Graft (CABG) in a single sitting.
During evaluation, the patient, Siva Prasad Rao, was found to have liver cirrhosis, liver cancer and significant coronary artery disease with critical blocks in the blood vessels to the heart. The surgery, spanning over fourteen hours, involved expertise of multi-specialty teams including cardiac, oncology and liver transplant.
The doctors said that the heart disease was found to be significant enough to preclude performing a liver transplant. They pointed out that coronary stenting was not an option as, after stenting, liver transplant could not be carried out for eight-twelve weeks, and waiting was not an option as the patient’s liver cancer could spread during the waiting time.
The doctors decided to perform liver transplant and coronary artery bypass at the same time. The 33-year-old daughter of the patient donated a part of her liver. The operations were carried out on December 6, 2019.
CABG was done first, followed by liver transplant. The donor was discharged on the sixth day after operation and the patient was discharged on the twelfth day after operation. Both the patient and donor are doing fine, say doctors.
“Meticulous planning, carefully timing the donor and recipient surgery and availing all concerned specialty services when needed, as recipient had to undergo cardiac bypass surgery first, followed by liver transplant, ensured incident free treatment," says Dr Manish C. Varma, Senior Consultant and HOD, Liver Transplant and HPB Surgery, Apollo Hospitals, Hyderabad.
The doctors pointed out that treating such cases successfully requires a multidisciplinary approach involving critical medical and surgical specialities, very competent nursing, support staff and an excellent hospital infrastructure.
They said that CABG and liver transplant are major and complex surgeries. Doing one after the other to give space for the patient to cope and recover from each of them wouldn't have saved the life of the patient and not treating the patient was not an option at all as the tumor was progressing rapidly and he wouldn't have survived for long.
Dr Manoj Agarwala, Senior Consultant Cardiologist, said that both the vessels of the patient were very critical, almost 80-90% of his heart was at risk, in fact right coronary was almost 99% blocked and at high risk, it seemed impossible to do a liver transplant for him with his state of the heart.
“But since the tumor was spreading fast, we had no option but to perform both CABG and Liver Transplant one after another in one sitting. If his heart condition was not assessed properly, the patient would have been lost during the transplant,” he added.