Beating Heart Bypass for Triple Vessel Disease

Surgeon: Dr. Vishal Khullar  |  Specialty: Cardiothoracic & Vascular Surgery, Heart and Lung Transplant

Hospital: Nanavati Max Super Speciality Hospital, Vile Parle West, Mumbai

Procedure: Redo Mitral Valve Replacement with Coronary Artery Bypass Grafting

Video Testimonial: youtu.be/kyfas1psgro

Patient Profile

The condition

The patient had previously undergone mitral valve replacement with a tissue (bioprosthetic) valve. Unlike mechanical valves, bioprosthetic valves do not require lifelong blood thinners, but they have a finite lifespan and are prone to structural wear over time. In this case the valve degenerated approximately three to four years after implantation. Its leaflets stiffened and could no longer open and close normally, a finding confirmed on 2D echocardiography. Further evaluation revealed a second, separate problem: significant blockages had developed in the coronary arteries supplying the heart muscle, confirmed on coronary angiography.

Emotional and psychological impact

Facing a second open-heart operation within a few years of the first is a daunting prospect for any patient. As the bioprosthesis failed, the patient developed breathlessness on exertion and episodes of chest pain — symptoms that limit everyday activity and can be distressing to live with. The return of a heart problem that had previously been corrected carries a real psychological burden, compounded by understandable anxiety about undergoing a more complex redo procedure combined with bypass surgery.

What was assessed during the consultation

• Symptom evaluation: breathlessness on exertion and chest pain
• 2D echocardiogram to assess the existing mitral bioprosthesis, which showed stiffened, degenerated leaflets
• Coronary angiogram, which demonstrated blockages in the coronary vessels
• Overall fitness for a redo (second) open-heart operation under general anaesthesia

Why this approach was chosen

Dr. Vishal Khullar counsels patients that there is no single “ideal” prosthetic valve. Tissue valves and mechanical valves each carry their own advantages and trade-offs. Here, two problems had to be resolved in a single operation:

• The degenerated tissue valve could not be repaired and required re-replacement, so a redo mitral valve replacement was planned.
• Because the angiogram confirmed coronary artery blockages, coronary artery bypass grafting (CABG) was planned in the same sitting, addressing both the valve and the heart’s blood supply together rather than across two separate operations.
• Combining the procedures spares the patient the cumulative risk of two separate open-heart surgeries.

For a case of this kind, the key baseline documentation is the 2D echocardiogram, showing the degenerated mitral bioprosthesis, and the coronary angiogram, showing the vessel blockages. Together these confirm the diagnosis and define the surgical plan.

Step-by-step overview

1. Pre-operative assessment confirmed against the echo and angiogram findings.
2. General anaesthesia administered.
3. Chest re-opened via redo sternotomy, with careful dissection through scar tissue from the previous surgery.
4. Patient placed on cardiopulmonary bypass (heart–lung machine).
5. Degenerated mitral bioprosthesis explanted and a new prosthetic mitral valve implanted (redo mitral valve replacement).
6. Coronary artery bypass grafting performed to bypass the blocked coronary vessels.
7. Patient weaned off cardiopulmonary bypass; heart function and valve seating confirmed.
8. Layered closure of the chest.

Procedure facts

Today I feel stronger and able to return to my daily routine at home. I’m deeply grateful to Dr. Vishal Khullar and his team for giving me a renewed sense of health and a second chance. I wouldn’t hesitate to recommend him to anyone facing complex heart surgery.”

 

Profile	Female · [61] years · [Homemaker] · [City]
Procedure	Redo mitral valve replacement + bypass surgery
Surgeon	Dr. Vishal Khullar

Instructions typically given after this procedure

The points below reflect standard post-cardiac-surgery guidance. The exact instructions given to this patient should be confirmed against her discharge summary.

• Medications taken exactly as prescribed (confirm the specific regimen for this patient)
• Sternal (breastbone) precautions avoiding heavy lifting, pushing, or pulling while the breastbone heals, typically for around six to eight weeks
• A gradual, supervised increase in activity, often supported by cardiac rehabilitation
• Wound care and monitoring for any signs of infection
• Heart-healthy diet and lifestyle measures to protect the bypass grafts
• Scheduled follow-up visits, including echocardiography to assess the new valve

Procedure Facts

The post operative course was smooth and uneventful. The patient was mobilised early, walking in the ICU within two days of surgery, and was discharged on the fifth post operative day. By around the fifteenth day his sutures had been removed and he was walking comfortably and managing daily activities independently. For patients at this stage, the practical guidance on recovering from heart surgery covers what to expect and which warning signs to watch for. The surgical goal of restoring reliable blood supply to the heart with durable arterial grafts was fully achieved.

Recovery timeline