Amrita Hospital Performs Rare Fourth-Time Redo Bentall Surgery Successfully

A 52-year-old Pune resident was recently discharged after the successful  fourth open-heart surgery, an extraordinary feat made possible by a high-risk procedure at Amrita Hospital, Faridabad. “We faced multiple challenges. Every step was demanding due to extremely distorted anatomy due to adhesions post previous cardiac surgeries. One of the coronary arteries was injured during dissection. We had to adjust and adapt to various challenges during this surgery” said Dr Sameer Bhate, Senior Consultant and Head of Adult Cardiac Surgery at Amrita Hospital, where the surgery was performed on August 12.

After hours on the operating table, the surgical team anticipated a high risk of postoperative bleeding. “We decided to leave his chest open and carefully packed for 24 hours before closing it the next day a technique I learned from my father. These are not routine steps, but sometimes they’re the only way to decrease post-operative bleeding and reduce the risk of complications like compression of the heart due to collection of blood and also reduce the blood transfusion requirements,” Dr Bhate explained.

The surgery lasted 11 hours, with the patient on cardiopulmonary bypass for seven hours. The patient, Ayush (name changed), had a long history of rheumatic heart disease that had progressively damaged both his mitral and aortic valves. His cardiac journey began in 2002 when senior cardiovascular surgeon Dr Sudhir Bhate Dr Sameer’s father replaced both valves with biological ones at a private hospital in Pune. Patient choose these valves as he did not want to take blood thinners which one has to after replacement with mechanical valves.

A decade later, in 2012, the replaced valves had degenerated and were re-replaced again by the Bhate’s. In 2022, Ayush underwent a third surgery to replace the mitral valve with a mechanical one. This was done by Dr Sameer Bhate in Pune. By December 2024, he developed symptoms again this time due to degeneration of the biological aortic valve.

“Several doctors in Pune declined to operate, citing the high risk,” Ayush said. “I was told I might not survive a fourth surgery. But by God’s grace, I got a second chance at life. I’m deeply grateful.” Dr Sudhir Bhate said his son was confident that the surgery could be safely performed with the support of a skilled team of anaesthetists, perfusionists, and nurses at Amrita Hospital. Ayush was admitted on August 11 and discharged on August 21 after a full recovery. He flew back to Pune on August 23.
“The patient’s cardiac history spans over two decades,” Dr Sudhir added. “His first surgery replaced both valves. A decade later, those tissue valves wore out. In 2022, the mitral valve failed again and was replaced with a mechanical one. By 2024, he was symptomatic once more.”
Redo cardiac surgeries are technically demanding. Dr Sameer Bhate has performed 138 redo cardiac surgeries including 4 third times redo heart surgeries.

Surgical Highlights: A Case of Rare Complexity

• Fourth-time redo surgery: Aortic biological valve had degenerated; mechanical replacement was advised.
• Had to convert to a Bentall procedure instead of only an Aortic valve replacement. Bentall surgery is a complex operation which involves replacing the aortic valve and the ascending aorta and reimplantation of the coronary arteries.
• Unconventional access: Prior surgeries made initiating  standard bypass impossible due to hostile anatomy.
• Surgeons improvised to expose the artery and veins in the abdomen to enable initiation of cardio pulmonary bypass .
• Intraoperative arterial tear: One of the heart’s arteries tore duridng surgery and was repaired with a coronary artery bypass.
• Open chest strategy: Due to high bleeding risk, the chest was left open and packed for 24 hours before final closure.
• This is not merely a surgical feat; it is a national milestone, possible due to the team of doctors which comprised of  Cardiac Anaesthetists : Drs Dheeraj Arora, Shweta Panse , Rahul Maria, Rajesh Pandey, Prabhat Chaudhary ,
Team of nephrology: Dr Urmila Anandh, Dr Harsha ID, Dr Rohit Garg and Urosurgeon  Dr Manav Suryavanshi,
Perfusionists: Ravi Deshpande, Faisal Zain and Thushara Mohan, PA Ruhul Khan and the incredible Surgical OT staff nurses, dedicated ICU nurses and ward nurses.

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