Apollo team pulls off complex robotic heart surgery

A 37-year-old man has undergone a rare and highly complex combined robotic heart surgery at Apollo Hospitals, Jubilee Hills, bringing together multi-vessel coronary artery bypass grafting and mitral valve replacement in a single minimally invasive procedure.

The patient, who had been experiencing progressive breathlessness while exerting himself, was diagnosed with severe calcific rheumatic mitral stenosis and triple-vessel coronary artery disease. His mitral valve opening was severely narrowed to just 0.9–1.0 sq cm, although his heart’s pumping function remained preserved at 60 per cent.

The complexity of the case was compounded by significant enlargement of the left atrium. Coronary angiography revealed blockages in all three major coronary vessels, requiring comprehensive revascularisation along with replacement of the diseased mitral valve.

Dr A. Nagesh, Cardio Thoracic and Minimally Invasive Cardiac Surgery (MICS), Heart Transplantation, said the surgical team first harvested both internal mammary arteries robotically. Multiple bypass grafts were then performed, including a LIMA-to-LAD graft, a composite LIMA-RIMA Y-graft to the obtuse marginal artery and a saphenous vein graft to the posterior descending artery.

However, the surgery took an unexpected turn when the team opened the left atrium for mitral valve replacement. Despite the absence of any thrombus on both preoperative transthoracic echocardiography and intraoperative transoesophageal echocardiography, an organised blood clot was unexpectedly discovered inside the left atrium.

The thrombus was completely removed, after which the surgeons proceeded with robotic mitral valve replacement using a 27-mm St. Jude mechanical prosthesis.

The combined procedure required 216 minutes of cardiopulmonary bypass and 120 minutes of aortic cross-clamping. Despite the complexity and duration of the surgery, the patient recovered without complications and was discharged on the sixth postoperative day.

Dr A. Nagesh, Cardio Thoracic and Minimally Invasive Cardiac Surgery (MICS), Heart Transplantation, Apollo Hospitals Jubilee Hills said the case highlights how advanced robotic cardiac surgery can be used to tackle multiple serious cardiac problems in a single sitting while retaining the principles of conventional cardiac surgery. The unexpected discovery of the left atrial thrombus, despite negative echocardiographic findings, further underlined the importance of careful surgical evaluation.

The successful procedure is significant not only because of the patient’s young age, but also because it combined multi-vessel coronary revascularisation, robotic mitral valve replacement and removal of an unsuspected left atrial thrombus in one minimally invasive operation.