For the first time in the medical history, awake cardiac surgery on a patient with “Bombay Blood Group” (VIDEO)
First time in the world medical history, a very rare heart surgery performed by Dr. Nisarga, Consultant cardiovascular surgeon, India. In this unique surgery patient witnesses her own heart being operated when she is fully awake for about 4 hours without using the ventilator. Heart was completely stopped and she was not breathing for hours, but was completely awake. She has ‘Bombay Blood Group’ which is a very rare blood group in the world (Only about 179 people identified with this blood group in the world).
Heart surgery can correct problems with the heart if other treatments haven’t worked or can’t be used. The most common type of heart surgery for adults is coronary artery bypass grafting (CABG). During CABG, a healthy artery or vein from the body is connected, or grafted, to a blocked coronary (heart) artery.
Doctors also use heart surgery to
Repair or replace heart valves, which control blood flow through the heart
Repair abnormal or damaged structures in the heart
Implant medical devices that help control the heartbeat or support heart function and blood flow
Replace a damaged heart with a healthy heart from a donor
Treat heart failure and coronary heart disease
Control abnormal heart rhythms
Heart surgery has risks, even though its results often are excellent. Risks include bleeding, infection, irregular heartbeats, and stroke. The risk is higher if you are older or a woman. The risk is also higher if you have other diseases or conditions, such as diabetes, kidney disease, lung disease, or peripheral arterial disease.
Heart surgeries are made by a cardio thoracic surgeon who is a medical doctor who specializes in surgical procedures of the heart, lungs, esophagus, and other organs in the chest. This includes surgeons who can be called cardiac surgeons, cardiovascular surgeons, general thoracic surgeons, and congenital heart surgeons.
What is Bombay blood group
Bombay blood group is the rarest blood group. First found in Bombay (Mumbai) in India, hence called Bombay blood group. It is observed to occur in 1 out of every 250,000 people except in parts of India where the incidence has been observed to be as much as 1 in every 7,600.
It is also called the HH group. The peculiarity is that they do not express the H antigen. As a result they cannot form A antigens or B antigens on their red blood cells. Thus they can donate blood to anybody with ABO grouping but can receive blood only from Bombay blood group people.
To understand Bombay blood group we must understand the details of blood grouping. When we say someone has blood group A, it means that the person has antigen of type ‘A’ and antibody of type ‘B’ in his/her blood. People with AB have both antigen A and B in their blood and no antibodies. People with O blood group have only antibodies A and B and no antigens. However what is not generally known is that all these groups have an antigen H in the blood as well. There are very few people who do not have this antigen H also in their blood. Instead they have antibody H because of which no other blood can be given to them.
In a rare, successful attempt, doctors at Indiana Hospital in the city performed a cardiac surgery on a female patient even as she stayed awake during the entire procedure. For the first time in India, this kind of ‘awake cardiac surgery’ was performed on a patient with the rare Bombay blood group.
A patient hailing from Sakaleshpur, aged 36 years, came to Indiana Hospital and was diagnosed to have a congenital heart disease, atrial septal defect, commonly known as hole in the heart, which was present in her from the time of birth. Pure and impure blood used to get mixed in her heart.
If left alone, eventually it can lead to death. She was suffering from difficulty in breathing from long time. She had severe lung disease which is high risk factor and life threatening to put her on general anaesthesia and ventilator during heart surgery. The patient was taken for a series of investigations.
The cardiology team headed by Dr Yusuf Kumble, chief interventional cardiologist and managing director, Indiana hospital, in association with Dr Manjunath, consultant cardiologist, conducted cath-angiogram study to assess and decide about the plan of surgery.
Dr Nisarga, chief consultant cardiac surgeon at Indiana hospital, decided to do “awake cardiac surgery” on her in view of bad lung condition.
Patient’s blood investigations revealed that she had a very very rare blood group which is called Bombay Blood Group. Patient can not be transfused with any of the common blood groups like ‘A’, ‘B’, ‘AB’ and ‘O’, which can be fatal. There are only 179 cases reported in the world to have this rare blood group. It derives its name by the city in which it was found out. But it is seen all over the world like Japan, China and Europe. After an extensive search across the country, one donor was identified in Mangalore itself with this rare blood group. He voluntarily donated the blood.
A day before surgery, an epidural catheter was introduced to her spinal canal, behind the neck to give a special form of “low cervical epidural anaesthesia”. This will numb only the chest part of the body.
Heart surgery was conducted by Dr Nisarga and his team on October 11, which lasted for about 5 hours. The patient was widely awake and conscious during the heart surgery. Her heart was cut open to correct the problem and her breathing was stopped for about four hours, still she was awake, having no pain.
Although blood was arranged, surgery was conducted successfully without any blood transfusion. Without a standby blood, her heart surgery would have been impossible.
The surgery was done free of cost under state govt. Vajapeyi Arogya Health Scheme. Now she is comfortable and can resume her normal activities after discharge. Dr Nisarga who conducted this rare operation feels that a hard work in getting the blood donor saved a life and it was challenging to perform the surgery when she was awake.
In Dr Nisarga’s cardiac surgery team cardiac anaesthetists Dr Ronald, Dr Nagesh, assistants Maaz and Irshad were there. “Another mile stone is reached at Indiana hospital and heart institute in treating the patients with heart diseases”, opined Dr Yusuf Kumble, managing director and chief cardiologist, Indiana Hospital.
This historic heart operation was done for the first time ever in South Canara district. This type of awake cardiac surgery with Bombay blood group is first of its kind in India. Mangalore city witnessed a very rare event in the history of medicine.