The Wockhardt Heart Institute here, the flagship heart hospital of the Wockhardt Hospitals group, has set another benchmark in heart surgery, by successfully performing an Awake Minimally Invasive Heart Valve Repair Surgery (AMIHVRS) on a 49-year-old woman here recently. Addressing a press conference here, Wockhardt Chief Cardiovascular and Thoracic Surgeon Dr Vivek Jawali said his team had conducted the surgery without using general anesthesia or ventilator support, while the patient was on a heart lung machine.

He said the patient had multifaceted medical complications, including an aortic valve disorder. Her lung condition did not permit the use of a ventilator and she was at high risk for general anesthesia.

Dr Jawali said ''having suffered with these symptoms for a prolonged period and being put on medication for several years by various centres, before she came to us, had complicated her risk of open heart surgery.'' Though she had been advised aortic valve replacement surgery, after reviewing her case, his team and he had devised a surgical procedure to repair, rather than replace the aortic valve through a minimal incision, while using the technique of high thoracic epidural analgesia, Dr Jawali said.

The Procedure done successfully on the patient had thrown open a new dimension in awake heart surgery, Dr Jawali said.

The technique of High Thoracic Epidural Analgesia (HTEA) was highly precision based methodology which involved injection of micro doses of local anaesthetic in the epidural space around the spinal cord which anesthetises only the chest region, while the rest of the system was fully awake. This enabled a painless chest surgery and makes the surgery safe for patients who were at high risk for general anesthesia, he explained.

Through this dedicated programme on minimally invasive heart valve repair surgery, the Hospitals was focusing on treatment for Rheumatic heart disease, which continued to be an important cause of morbidity and mortality in India and Asian countries due to inaccessibility of patients to afford heart valves.

The new surgical method minimises blood loss, infection and limited hospitalisation to three to five days and enabled the patient to resume normal activities sooner.

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Latest in 'awake' heart surgeries

The Wockhardt Heart Institute has initiated an 'Awake minimally invasive heart valve repair surgery' programme, which promises to take 'awake' heart surgeries to a new level.

In a breakthrough heart surgery conducted at the hospital recently, the team conducted a minimally invasive heart valve repair without using general anaesthesia or ventilator support while the patient was on a heart-lung machine.

"The 49-year-old patient had many medical complications including an aortic valve disorder. Her lung condition did not permit the use of a ventilator and she was a high risk for general anaesthesia. She had been advised a valve replacement surgery, but we decided to repair it instead," Dr Vivek Jawali said.

The doctors used a technique called 'high thoracic epidural analgesia' where local anaesthesia is given only to the chest region, while the rest of the system is fully awake.

Advantages

The advantage of this procedure, according to Dr Jawali, is that the heart's natural anatomy is preserved and patients do not need to take any blood thinner medications. Valve repair through minimal incision on an awake patient reduces blood loss, minimizes the chance of infection and allows patients to resume normal activities sooner. The incision is minimal and thus leaves a smaller scar.

The average stay in the hospital is only three to five days when compared to seven days in the case of regular surgeries. Recovery time after discharge is much faster and more importantly, the patient goes through less pain and trauma, Dr Jawali added.