A 24-year-old Mr. Khattab Omar Rashid from Oman was admitted to Jaslok Hospital & Research Centre in Mumbai on 9th October 2023 for the management of a complex heart problem.

He had previously undergone four open heart surgeries, the most recent one being about two months ago in another hospital in India. The patient was in critical condition, experiencing heart failure and an active infection.

The sequence of surgeries began with the first operation addressing a birth defect of the heart (subaortic membrane removal). Subsequently, he required another operation to correct the aortic valve, which was replaced. However, a leak developed beside the valve, leading to two more surgeries in Oman. Despite a surgery in India for the infected valve, the patient continued to experience complications, ultimately being diagnosed with an ascending aortic aneurysm, a condition where the main blood vessel from the heart becomes dilated like a balloon, carrying a risk of rupture.

Managing an aortic aneurysm, particularly when it has eroded the back of the breastbone, and undergoing repeat open heart surgery is an exceedingly high-risk procedure. Such cases are typically handled in specialized quaternary care centers like Jaslok Hospital & Research Centre. These procedures pose significant risks, including excessive bleeding and potential damage to vital organs such as the brain, kidneys, and liver, especially when there is an active infection.

The patient’s treatment at Jaslok Hospital involved a ‘Heart Team Approach’, a collaborative effort comprising experienced Cardiac Surgeons, Cardiologists, Anaesthetists, Intensivists, Infection Specialists, and Technologists. This complex surgery was successfully  carried out by the team headed by Dr Suresh Joshi, Director Cardiovascular & Thoracic Surgery and assisted by Dr Upendra Bhalerao, Consultant Cardiovascular & Thoracic Surgery, Dr Rajashri Agasakar, Consultant Anaesthesia, Dr Anurag Jain, Consultant Cardiac Anaesthesia and  Mr. Kiran Ambre, Heart & Lung Machine Technologist (special expertise for such complex cases). The post-operative care was looked after by Dr Indraneel Raut, Additional Director Critical Care Medicine, Dr Rahul Chabbria, Consultant Cardiology, Dr. Mala Kaneria, Consultant Infectious Disease and Dr Samir Shah, Consultant Haematology, at Jaslok Hospital & Research Centre.

During the surgery, the aneurysm was removed along with the infected aortic heart valve, and the aortic root was replaced with an aortic homograft—a tissue graft obtained from a cadaveric donor. Procuring the homograft from the valve bank in Chennai posed logistical challenges. The use of a homograft, is a preferred option in the presence of infection, and is uncommon due to the scarcity of organ donations and valve banks. The nursing staff wholeheartedly endorsed and collaborated seamlessly with the medical practitioners

Dr. Suresh Joshi, Director Cardiovascular & Thoracic Surgery, Jaslok Hospital & Research Centre highlighted the Hospital’s status as a referral center for complex aortic surgeries and re-operative heart surgeries across the world. He emphasized, “5th Repeat Open heart surgery is rare and poses extreme technical challenges. Considering the inherent risks associated with such multiple open heart surgeries and the intricate nature of the recent procedure. It speaks to the hospital’s commitment to excellence in cardiac care, as well as the patient’s resilience and the effectiveness of the ‘Heart Team Approach’ employed in managing such complex cases. We were confident that we could handle this case successfully.  Jaslok Hospital continues to be a Centre of Excellence for heart valve surgery and minimally invasive heart surgery, attracting patients from across India and around the world”.

“This is the first-time homograft is successfully used in recent times in Maharashtra and perhaps in the whole of India in case of a 5th repeat heart surgery. This is a testament to the precision, expertise, and comprehensive care provided by the medical team at Jaslok Hospital” added Dr Upendra Bhalerao, Cardiovascular & Thoracic Surgery, Jaslok Hospital & Research Centre who assisted the surgery.

Dr. Indraneel Raut, Additional Director of Critical Care Medicine, Jaslok Hospital & Research Centre who looked after the post-operative care of the patient mentioned, “Khattab was a challenging case as he had already undergone multiple surgeries on the heart which was complicated further by endocarditis. However our surgeons did a fantastic job and the post-operative course was uneventful unlike what one would expect after such surgery. And with a team effort we could ensure a good recovery. We wish the patient a speedy recovery!”

The patient, Mr. Khattab Omar Rashid, and his brother Walid expressed their delight and gratitude to the Jaslok Hospital team for his survival and restored health & he expressed gratitude for surviving his life-threatening heart issue, commending the meticulous planning and execution of the high-risk procedure by the Jaslok team. He was discharged on 8^th November, 2023 hail and hearty.