Pune, Oct 14: Doctors at DPU Super Specialty Hospital, Pimpri, Pune, successfully performed minimally invasive coronary artery bypass surgery on a 46-year-old man weighing approximately 130 kg, who had recurrent coronary blockages along with diabetes and obstructive sleep apnea.
The patient had undergone angioplasty for multiple coronary blockages around three years earlier. Within two to three years, he developed recurrent and critical blockages and was subsequently advised to undergo coronary artery bypass grafting. After consultations at multiple hospitals, he was referred for surgical management.
Considering the additional challenges associated with severe obesity, diabetes and obstructive sleep apnea, Dr. Ashish Baviskar, Cardiovascular, Thoracic & Vascular and Advanced Cardiac Surgeon at DPU Super Specialty Hospital, and his team opted for a minimally invasive approach to CABG.
Bypass surgery without opening the breastbone
Instead of a conventional median sternotomy, the surgical team accessed the heart through an approximately 3–5 cm incision between the ribs, avoiding division of the breastbone.
“Minimally invasive cardiac surgery allows us to perform complex cardiac procedures through a much smaller surgical access while avoiding sternotomy. In this patient, his obesity, diabetes and obstructive sleep apnea added to the perioperative complexity, making careful surgical planning particularly important,” said Dr. Ashish Baviskar.
A conventional sternotomy involves dividing the breastbone to access the heart. Avoiding this approach may reduce some of the challenges associated with sternal wound healing and mobilisation, particularly in selected patients with risk factors such as obesity and diabetes.
However, the suitability of minimally invasive surgery depends on coronary anatomy, previous procedures, overall health and surgical expertise.
Anaesthesia required careful planning
The patient’s severe obesity and obstructive sleep apnea also presented additional anaesthetic challenges, particularly with airway management, ventilation, oxygenation and postoperative extubation.
“Patients with severe obesity and obstructive sleep apnea require careful perioperative airway and respiratory planning. Our focus was on maintaining adequate ventilation and oxygenation throughout surgery, appropriate positioning and drug dosing, and ensuring safe extubation after the procedure,” said Dr. Venuraj Warke, treating anaesthesiologist.
Despite these challenges, the patient was successfully extubated approximately two hours after surgery. “Early recovery has been encouraging. Our focus is to ensure safe recovery and help the patient return to his routine at the appropriate stage,” Dr. Baviskar said.
A multidisciplinary approach to complex cardiac care
Minimally invasive cardiac surgery is an option for carefully selected patients and can provide an alternative to conventional sternotomy. The approach requires assessment of coronary anatomy, previous interventions and the patient’s overall medical condition, along with appropriate surgical and anaesthesia expertise.
In patients with multiple comorbidities, perioperative management involves coordinated care among cardiac surgeons, cardiologists, anaesthesiologists, intensivists, respiratory specialists and nursing teams. The supporting team members are Miss Bharati, Mr Gowhar, Mr Dishant, ICU nursing team and Physiotherapist team.
The DPU team said the case highlights the potential role of advanced surgical capability, multidisciplinary expertise and precision-driven cardiac care in appropriately selected patients with significant comorbidities.
Institutional commitment to advanced cardiac care
Dr. P.D. Patil, Chancellor, Dr. D.Y. Patil Vidyapeeth (Deemed to be University), Pimpri, Pune, said,
“This complex case demonstrates the importance of combining advanced cardiac surgical expertise, multidisciplinary decision-making and patient-centred care. Our endeavour is to continuously expand access to sophisticated cardiac treatment and ensure that patients with complex medical needs can receive appropriate surgical care close to home.”
Dr. Bhagyashree P. Patil, Pro-Chancellor, said,
“The successful use of a minimally invasive approach in a patient with multiple clinical challenges reflects the growing potential of precision-driven cardiac surgery. Our focus remains on adopting appropriate advanced techniques that can reduce surgical burden while maintaining patient safety and supporting recovery.”
Dr. Yashraj Patil, Trustee & Treasurer, said,
“Advanced healthcare is not defined only by technology, but by the ability to translate expertise, infrastructure and multidisciplinary care into meaningful outcomes for patients. We remain committed to strengthening our cardiac sciences programme with contemporary surgical capabilities and bringing advanced cardiac care within reach of patients in the region and beyond.”
The hospital’s Cardiac Sciences Centre includes Cardiology and Cardiovascular and Thoracic Surgery, with minimally invasive cardiac procedures offered as part of its cardiac surgical services.
