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Triple Vessel CABG Recovery

Triple Vessel Coronary Artery Bypass Surgery in a Patient with Diabetes and Reduced Ejection Fraction

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

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

Procedure: Coronary Artery Bypass Grafting using Bilateral Internal Thoracic Arteries and Left Radial Artery Conduit

Video Testimonial: youtu.be/kyfas1psgro

PATIENT PROFILE

Patient details below have been recorded in line with confidentiality conventions for written case studies. The patient has separately provided consent for an on-camera testimonial published on Dr. Khullar’s official channel, which is linked in Section 09a.

Age	52 years
Gender	Male
Occupation	Working Professional
Residence	Resident of Dubai, treated in Mumbai
Presenting Complaint	Chest pain and breathlessness on exertion
Diagnosis	Critical triple vessel coronary artery disease with reduced left ventricular function
Duration of Issue	Approximately 1.5 years (post prior cardiac event)
Co-morbidities	Type 2 Diabetes Mellitus, Hypertension
Previous History	Previous myocardial infarction roughly 1.5 years prior
Date of Procedure	Confirmed admission and surgery (per clinical record)
Outcome	Successful — uneventful recovery

THE CLINICAL PROBLEM

Condition

The patient presented with chest discomfort on exertion and reduced exercise tolerance. Clinical evaluation pointed toward advanced coronary disease in a heart already weakened by an earlier infarction. Echocardiography confirmed a left ventricular ejection fraction of 30 percent, indicating significantly reduced pumping efficiency. Coronary angiography revealed critical narrowing across all three major coronary territories, classified as triple vessel disease. The condition was severe and warranted urgent surgical intervention through heart bypass surgery to restore coronary perfusion and protect the remaining myocardium.

Impact on the Patient

The patient had been managing two long-standing chronic conditions, diabetes and hypertension, both of which independently raise cardiac risk. After his previous heart attack, daily life had become measured by what activity he could tolerate. Travel from Dubai to Mumbai for definitive treatment was prompted by worsening symptoms and the recognition that medical therapy alone would no longer suffice. By the time he reached our outpatient clinic, even ordinary exertion was producing chest discomfort. The clinical picture was time sensitive, and the family arrived seeking a surgical team experienced in high risk coronary cases.

CONSULTATION AND TREATMENT PLAN

What Was Assessed During the Consultation

Echocardiographic assessment of ventricular function, with documented ejection fraction of 30 percent
Coronary angiographic review confirming critical disease in all three major vessels
Glycaemic and blood pressure control reviewed against optimal pre-operative targets
Assessment of conduit availability for bypass grafting, including chest wall arteries and forearm vessels
Anaesthetic and surgical fitness review given reduced ventricular reserve
Discussion with the patient and family regarding risk profile, expected recovery, and long term outlook

Why This Surgical Approach Was Chosen

Triple vessel coronary artery disease with reduced ejection fraction has a clear evidence base favouring surgical revascularisation through coronary artery bypass grafting over percutaneous options
Bilateral internal thoracic arteries were selected as conduits because arterial grafts demonstrate superior long term patency compared with venous grafts, particularly relevant for a relatively young patient with decades of life ahead
The left radial artery was added as a third arterial conduit to maximise complete arterial revascularisation, an approach favoured in younger diabetic patients to reduce the future need for repeat interventions
The strategy was tailored around two priorities: durable graft patency and protection of the already compromised left ventricle

PRE-OPERATIVE IMAGING AND WORKUP

Pre-operative documentation included resting echocardiography, coronary angiography, baseline biochemistry with HbA1c, and standard cardiac surgical workup. Imaging confirmed the surgical plan and the choice of conduits.

Figure 1. Pre-operative coronary angiogram — schematic representation of triple vessel disease across the LAD, LCX, and RCA territories

Figure 1. Pre-operative coronary angiogram — schematic representation of triple vessel disease across the LAD, LCX, and RCA territories

PROCEDURE DETAILS

Step-by-Step Surgical Overview

Patient transferred to the cardiac operating theatre with full invasive monitoring established
General anaesthesia administered with cardiac specific induction protocol given reduced ejection fraction
Median sternotomy performed and pericardium opened
Bilateral internal thoracic arteries harvested in skeletonised fashion to preserve flow and minimise sternal devascularisation
Left radial artery harvested from the non dominant forearm following pre operative Allen test confirmation
Cardiopulmonary bypass instituted with careful attention to perfusion pressures
Distal anastomoses constructed sequentially to the targeted coronary territories using the three arterial conduits
Proximal connections completed and grafts assessed for flow
Weaning from cardiopulmonary bypass with appropriate inotropic support, given the pre operative ejection fraction
Sternum closed in standard fashion with layered wound closure

The choice of complete arterial revascularisation reflects Dr. Khullar’s training at Mayo Clinic and Cleveland Clinic in the United States, where multi-arterial conduit strategies are standard for younger patients and patients with diabetes.

Procedure Facts

Procedure	Coronary Artery Bypass Grafting (Triple Vessel)
Anaesthesia	General anaesthesia with cardiac specific protocol
Conduits Used	Bilateral Internal Thoracic Arteries plus Left Radial Artery
Approach	Median sternotomy with cardiopulmonary bypass
Special Considerations	Pre-operative ejection fraction 30 percent; diabetic patient
Intra-operative Course	Stable; no adverse events recorded
Total Theatre Time	Within standard duration for triple vessel arterial revascularisation
Hospital Stay	Discharged on post operative day 5

Figure 3. Intra-operative surgical schematic — complete arterial revascularisation using bilateral internal thoracic arteries and the left radial artery conduit

POST-OPERATIVE RESULTS

Recovery progressed in line with the surgical plan. The patient was extubated on post operative day 1 and discharged on post operative day 5. Symptom relief was reported early in the recovery phase, and clinical observation at follow up confirmed restored exercise tolerance with no recurrence of angina. Glycaemic control and blood pressure were stabilised within the recovery period.

Figure 4. Post-operative functional recovery trajectory — uneventful course from extubation through discharge and return to routine activity

Outcomes at a Glance

Outcome Metric	Result
Revascularisation	Complete arterial revascularisation across all three target vessels
Extubation	Day 1 post-operative — uneventful
Discharge	Day 5 post-operative
Symptom Relief	Resolution of exertional chest pain and breathlessness
Complications	None recorded during admission
Recovery Course	Smooth — within expected clinical timeline
Patient Reported Outcome	Returned to normal activity within roughly seven days at home

PATIENT FEEDBACK

Recorded during clinical follow up. Quotation reflects the patient’s own words.

I had travelled from Dubai to Mumbai because my condition had become critical. I am a diabetic patient and had a previous cardiac event some time before. When Dr. Khullar reviewed my reports, the situation was serious. The surgery was carried out and the recovery went well. Within seven days I felt healthy again. The doctor and the entire hospital staff looked after me thoroughly. I am grateful to Dr. Khullar and to Nanavati Max Hospital for the care provided.

Patient profile: Male · 52 years · Working Professional · Resident of Dubai

Procedure: Triple Vessel CABG · Nanavati Max Super Speciality Hospital, Mumbai

Surgeon: Dr. Vishal Khullar · Director, Cardiothoracic & Vascular Surgery, Heart and Lung Transplant

More patient experiences are available on the patient testimonials page.

PATIENT TESTIMONIAL VIDEO

The same patient and the operating surgeon are featured in an on-camera testimonial published on Dr. Vishal Khullar’s official YouTube channel. The video records the patient’s clinical history, the surgeon’s account of the operative decision, and the patient’s recovery in his own words. Click the thumbnail below or use the link to watch.

Video Title: Successful Bypass Surgery for Severe Coronary Blockages — Patient Testimonial featuring Dr. Vishal Khullar

Channel: Dr. Vishal Khullar (Official)

Featured Voices: The patient, and Dr. Vishal Khullar, Director, Cardiothoracic and Vascular Surgery, Nanavati Max Super Speciality Hospital, Mumbai

POST-PROCEDURE CARE AND RECOVERY

Instructions Provided to the Patient

Wound care protocol for the sternal incision and forearm conduit harvest site
Cardiac medications continued as prescribed, including antiplatelet therapy and lipid lowering agents
Glycaemic control maintained with insulin or oral agents as advised, with regular monitoring
Graded activity protocol — light walking from week one, gradual return to routine within six weeks
Lifting restrictions for the sternum to allow bone healing across six to eight weeks
Cardiac rehabilitation referral and structured follow up appointments

Recovery Timeline

Timeframe	Clinical Expectation
Day 1	Extubated; transferred to cardiac care unit; haemodynamics monitored
Day 2 to 4	Step down ward; mobilisation begins; glycaemic and pain protocols active
Day 5	Discharge home with detailed care instructions and medication chart
Week 1 to 2	Light activity at home; sternal precautions; first follow up review
Week 6	Return to normal day to day activity; sternal healing assessed
Month 3	Cardiac rehabilitation review; exercise tolerance reassessed
Month 6 to 12	Long term follow up; graft patency confirmed clinically; medication optimisation

FAQs

Q Why is bypass surgery preferred over stenting for triple vessel coronary disease in a diabetic patient with reduced heart function?

Long term studies have consistently shown that surgical revascularisation provides better survival and lower rates of repeat intervention in diabetic patients with disease across all three coronary territories, particularly when the heart’s pumping function is reduced. Read more about heart bypass surgery in Mumbai performed by Dr. Vishal Khullar at Nanavati Max Super Speciality Hospital.

Q What is the advantage of using bilateral internal thoracic arteries and the radial artery during CABG?

Arterial grafts remain open longer than vein grafts over decades of follow up. Using two internal thoracic arteries from the chest wall together with a radial artery from the forearm provides complete arterial revascularisation, which lowers the long term need for further coronary interventions. This approach is well suited to younger patients and to those with diabetes.

Q How long does recovery take after triple vessel bypass surgery?

Most patients are extubated within twenty four hours, transferred out of intensive care within two to three days, and discharged home around day five to day seven. Light home activity resumes during the first two weeks, and routine work and travel are usually possible by six weeks. The sternum takes around six to eight weeks to heal.

Q Is heart bypass surgery safe in a patient who already has a low ejection fraction and diabetes?

Outcomes in such patients depend heavily on surgical planning, anaesthetic management, and perioperative care. With experienced teams and modern techniques, including arterial conduits and protective bypass strategies, results in high risk patients have improved substantially. Learn more about Dr. Vishal Khullar, whose training at Mayo Clinic and Cleveland Clinic informs his structured approach to high risk coronary cases.

Q Why do international patients travel to Mumbai for cardiac surgery?

Mumbai offers a combination of internationally trained cardiac surgeons, modern hospital infrastructure, and cost effective comprehensive care. International patients can contact the clinic directly to discuss travel arrangements, second opinions, and pre-arrival cardiac workup.

Q Where can I watch this patient’s full testimonial?

The patient’s full on-camera testimonial, along with Dr. Vishal Khullar’s clinical summary, is published on the surgeon’s official YouTube channel at youtu.be/kyfas1psgro. The recording covers the patient’s history, the surgical plan, and his recovery in his own words.

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