Mrs. XXYYZZ is a 59-year-old lady who has been managing diabetes and hypertension for a while now. These conditions had taken a toll on her kidney and had led to End-Stage Renal Disease (ESRD). She has been on hemodialysis for the past one year and is on the waiting list for a renal transplant
Nevertheless, during her pre-transplant cardiac evaluation, the lady complained of discomfort and dyspnea while performing physical activities. The treadmill test was positive and the coronary angiogram revealed three-vessel disease, which included the left main
Thus, the patient needed a cardiac intervention before considering her for renal transplant.
Mrs. XXYYZZ’s cardiac condition was a matter of great concern for her nephrologists and cardiologists. Since the patient’s kidney function was not up-to par, any form of major surgery was extremely risky for her. Nevertheless, since the lady had multiple vessel diseases, she needed Coronary Artery Bypass Grafting (CABG) to ensure that she will be a fit candidate for renal transplant. A cardiac surgery board review was conducted by the nephrology and cardiology team along with anaesthesiologists and cardiac surgeons. It was decided that high-risk Coronary Artery Bypass Grafting was the best course of action for the lady.
She was scheduled for Bypass Surgery on an earliest date possible at Dr. Rela Institute and Medical Centre, Chennai. Dr. Srinath and Dr. Senthilkumar both, experts in the field of high-risk cardiac surgeries, agreed to perform the procedure. When Dr. Srinath and Dr. Senthilkumar met the patient the day before her surgery, she told them “Fix my heart so that I can wake up with a new kidney some day”
A successful graft procedure was performed. Given the additional strain on Mrs. XXYYZZ’s kidney it was decided to perform off-pump CABG. The left internal mammary artery was grafted to the LAD and the right coronary and circumflex received vein grafts. The procedure lasted more than five hours during which the anaesthetists ensured that the patient’s haemodynamics did not deteriorate.
The patient’s post-operative period was also challenging as she had to undergo dialysis since her kidney was unable to excrete excess potassium. However, she did not suffer from any complications like infection or rhythm abnormalities. Ms. XXYYZZ responded well to the treatment and was able to sit up and speak to her family members by the fifth day. Moreover, she was also able to walk independently in the intensive care unit. By the tenth day, she was walking up and down the ICU corridor with the help of her physiotherapist.
Ms. XXYYZZ was discharged on the seventh day following the surgery with a good wound healing. She continued her dialysis and was put back on the renal transplant waiting list after three months. Today, the lady is on her way to recovery with a newly grafted heart and hopes to receive a new kidney in near future.
