Mrs. Geetha, a resilient 59-year-old woman, had long battled diabetes and hypertension. These silent culprits had gradually worn down her kidneys, leading to ESRD. For the past year, she had been undergoing regular hemodialysis and was already on the waitlist for a renal transplant.

However, during her pre-transplant cardiac evaluation—a standard but vital step—she began to experience chest discomfort and shortness of breath during routine activities. A treadmill test was positive, and subsequent coronary angiography revealed a serious roadblock: triple-vessel coronary artery disease, including involvement of the left main coronary artery.

The nephrology and cardiology teams were now faced with a crucial decision: Mrs. Geetha’s heart needed urgent attention before any transplant could be considered.

Given her advanced kidney disease, any major surgery posed a considerable risk. Yet, without cardiac revascularization, she was not a safe candidate for transplant. CABG was the best option—but it was high-risk.

Her case was discussed in a multi-specialty board review involving nephrologists, cardiologists, anesthesiologists, and cardiac surgeons. The conclusion was unanimous but cautious: proceed with high-risk CABG to stabilize her heart and keep her transplant hope alive.

Dr. Srinath and Dr. Senthilkumar at Dr. Rela Institute and Medical Centre, Chennai, both renowned for their expertise in handling complex cardiac cases, agreed to take on her surgery.

On the morning of surgery, Mrs. Geetha greeted the team with quiet strength. "Fix my heart," she said softly. "So I can one day wake up with a new kidney."

Under the skilled hands of Dr. Srinath and Dr. Senthilkumar, the team proceeded with off-pump CABG to avoid the additional burden of cardiopulmonary bypass on her already fragile kidneys. They successfully grafted the left internal mammary artery to the LAD and placed vein grafts to the right coronary and circumflex arteries.

The surgery lasted over five hours. Anesthesia was meticulously managed to maintain fluid balance, avoid hypotension, and support perfusion. Her kidneys, though struggling, held on.

The first few postoperative days were intensely monitored. Ms. Geetha required dialysis on postoperative day one due to rising potassium and fluid overload. CRRT was started, later transitioning to intermittent dialysis.

Despite the anticipated complications, there were no infections, no arrhythmias, and no hemodynamic crashes. Slowly, she turned the corner. By day five, she was sitting up and speaking to her family. By day ten, she was walking the ICU corridor, hand in hand with her physiotherapist.

Mrs. Geetha was discharged on postoperative day 7, her chest healing well and her spirits high. She resumed her regular dialysis schedule and was reinstated on the renal transplant list three months later.

Today, she continues her journey—stronger, with a mended heart and renewed hope for a second chance at life through transplant.