~The patient was a cancer survivor, his legs were amputated and suffered from multiple co-
morbidities~
Bangalore, 14 August 2024: Fortis Hospital Bannerghatta Road successfully treated a 64-year-old
male from Madagascar, suffering from Triple Vessel Coronary Artery disease (blockage in three
major arteries), an enlarged prostate and multiple co-morbidities. A multidisciplinary team of
Doctors – Dr. Sudarshan G T, Senior Consultant – Cardio Thoracic Vascular Surgery, Dr Srinivas
Prasad, Senior Consultant – Interventional Cardiology and Dr Mohan Keshavamurthy, Senior
Director – Urology, Uro-Oncology, Uro-Gynaecology, Andrology, Transplant & Robotic Surgery
along with a Vascular Surgeon, ENT Specialist, Endocrinologist, Nephrologist and a Pain & Palliative
Specialist treated the patient.
Patient Ramesh (name changed), a cancer survivor and a double amputee, faced a dire health crisis a
month ago when he complained of chest pain and shortness of breath. An angiogram – a crucial
imaging test that reveals the condition of blood vessel, was performed in Madagascar, which
revealed reduced blood flow to the heart (Acute Coronary Syndrome) leading to heart attack and
reduced blood flow to the rest of the body (Acute Left Ventricular Failure) highlighting an urgent
need for a bypass surgery. However, the conventional bypass surgery was not feasible for Ramesh
due to the amputation of both his legs, which meant he lacked viable veins for grafting. Additionally,
his severe mobility restrictions, relying entirely on an electric wheelchair, further complicated the
matter. Faced with these challenges and the lack of advanced medical technology in his country to
address such a complex case, Ramesh sought the expertise of doctors at Fortis Bannerghatta Road
for advanced treatment and a chance for improved health.
Upon admission at Fortis Bannerghatta, a comprehensive diagnostic evaluation revealed multiple co-
morbidities including triple vessel coronary artery disease, diabetes, acute kidney failure and an
enlarged prostate. Due to financial constraints, hemodynamic-assisted angioplasty – a minimally
invasive procedure to improve blood flow through blocked or narrowed arteries was not a viable
option. Consequently, Dr Sudarshan and Dr Srinivas recommended a hybrid surgical approach
combining traditional open surgery with minimally invasive techniques. The treatment plan involved
a robot assisted minimally invasive bypass grafting (MIDCAB, or Minimally Invasive Direct Coronary
Artery Bypass Surgery), followed by a Rotablation atherectomy assisted Angioplasty with
Percutaneous Coronary Intervention (PCI). Dr Mohan
Keshavamurthy suggested an UroLift procedure to address the enlarged prostate, while diabetes
and kidney failure were managed by the respective specialists.
Explaining the procedure, Dr. Sudarshan G T, Senior Consultant – Cardio Thoracic Vascular Surgery,
Fortis Hospital, Bannerghatta Road said, “Given the patient’s complex cardiovascular condition and
the high risks associated with traditional open-heart surgery, which requires a large incision in the
chest, we opted for a minimally invasive approach called Robot Assisted Minimally Invasive Direct
Coronary Artery Bypass (MIDCAB). This innovative treatment included a surgery designed to tackle
one or more blocked arteries using tissues through small surgical cuts. It reduces both recovery time
and surgical risks. The surgery took approximately 2 hours and once the patient was stabilised, he
was scheduled for rotablation assisted angioplasty with Percutaneous Coronary Intervention – a non-
surgical procedure to treat the blockages in the artery.”
Dr Srinivas Prasad, Consultant- Interventional Cardiology, Fortis Hospital, Bannerghatta Road “We
performed Rotablation assisted angioplasty with Percutaneous Coronary Intervention on the patient,
during which a tiny, diamond-coated tool that rotates at high speed was used to grind away hard,
calcium deposits inside arteries. After the calcium deposits are cleared, a catheter with a balloon at
the tip is guided to the site of the blockage in the artery, thereby widening the artery and improving
blood flow. A drug releasing stent was then placed in the artery to keep it open after the balloon was
removed. This drug is slowly released into the artery wall over time, preventing regrowth of tissue
within the artery. The procedure lasted for around 45 minutes to an hour. Following the procedure,
the patient was monitored in the hospital for 3-4 days, and then underwent a week of physiotherapy
to aid in his recovery. This timely intervention significantly contributed to the patient’s recovery and
overall health improvement. In the absence of these surgical interventions, in case the patient
suffered another heart attack it would have been difficult for the patient to survive.”
Dr Mohan Keshavamurthy, Senior Director – Urology, Uro-Oncology, Uro-Gynaecology, Andrology,
Transplant & Robotic Surgery at Fortis Hospitals, Bengaluru said, “Following the successful cardiac
surgery, we proceeded with the UroLift procedure to address the patient’s enlarged prostate also
known as Benign Prostatic Hypertrophy (BPH). BPH is a common condition that affects over 70% of
men in their 60s. Although benign and unrelated to prostate cancer, BPH can significantly impact a
man’s quality of life. As the prostate enlarges, it presses on and blocks the urethra (tube through
which urine leaves the body), potentially leading to permanent bladder damage if left untreated. To
address this, we opted for the minimally invasive UroLift technique where 4 small implants were
placed to gently lift and hold the enlarged prostate tissue away from the urethra preventing
blockage. This approach improves urine flow and preserves ejaculatory function without the need for
more invasive surgery. Given the complexity of the patient’s medical condition, this technique was
particularly well-suited and crucial to his overall recovery and well-being.”
Mr. Akshay Oleti, Business Head, Fortis Hospitals, Bengaluru said, “At Fortis Hospitals, our mission
is to provide world-class medical care tailored to the unique needs of each patient. We are proud to
have offered a comprehensive and innovative approach to Ramesh’s complex health challenges. By
leveraging our advanced medical technologies and the expertise of our multidisciplinary team, we
were able to deliver a seamless treatment experience. This case exemplifies our commitment to
combining cutting-edge techniques with compassionate care to achieve the best possible outcomes
for our patients.”
