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UAE: 65-year-old with multiple ailments undergoes complex surgery, gets discharged in a week

Given the extent of his heart disease, traditional methods like stenting were not feasible for the elderly patient

A 65-year-old male, who had been living with Type 2 Diabetes Mellitus for many years, experienced alarming symptoms, including reduced urine output and breathlessness. He was taken to the emergency department at the RAK Hospital in Ras Al Khaimah, and diagnostic tests revealed that he had suffered a heart attack – further complicated by the adverse effects of long-term diabetes on his kidneys.

Given the extent of his heart disease, traditional methods like stenting were not feasible, and the patient required coronary artery bypass surgery. However, his compromised heart function and renal impairment posed additional challenges for the surgical team.

The doctors at the hospital performed a coronary artery bypass surgery (CABG) on the high-risk patient without the use of a cardiopulmonary bypass machine. The innovative approach, conducted while the patient's heart was still beating, proved to be a game-changer for individuals with complex medical conditions, such as severe heart and kidney damage.

“The patient had both heart and kidney damage due to diabetes. His condition was initially deemed unfit for angiography, requiring multiple cycles of dialysis to improve his overall health before the procedure could be performed,” said Dr Adil Rizvi, Chief Cardiac Surgeon and Joint Medical Director at RAK Hospital.

Conventionally, CABG surgery involves stopping the heart and using a cardiopulmonary bypass machine to maintain blood circulation. However, this method requires a significant amount of fluid to prime the machine, leading to potential complications and inflammation.

“Given the circumstances, the surgical team made the decision to conduct the surgery while the heart was still beating, a challenging task that demands specialised equipment and extensive experience to stabilise specific areas of the heart during the operation,” said Dr Rizvi.

In a remarkable departure from conventional practice, the cardiac surgeons at the hospital opted for a beating-heart surgery approach. This technique, which requires specialised equipment and extensive expertise, allows surgeons to operate on the heart while it is still functioning. By avoiding the use of a bypass machine, the risks associated with fluid overload and inflammation were significantly reduced, particularly for patients with pre-existing kidney conditions.

The patient experienced a smooth recovery and was discharged within a week, with instructions to prioritise self-care and better management of his health.

Dr Rizvi emphasised the importance of recognising atypical symptoms of a heart attack, particularly in diabetic patients. “Symptoms such as excessive sweating, vomiting, arm or jaw pain, and a feeling of unease could indicate a heart attack, even without the presence of chest pain. Diabetic individuals should be vigilant and not ignore any of these warning signs.”

Dr. Raza Siddiqui, Executive Director, RAK Hospital said: “The successful outcome of this surgery reaffirms our commitment to delivering advanced and patient-centric care. By adopting innovative techniques and leveraging our experience, we can provide viable treatment options for individuals who may not have been suitable candidates for traditional procedures”, added Dr Siddiqui.

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