Dr Ramakanta Panda at the news conference after the surgery. (AP)

New Delhi, Jan. 24: Prime Minister Manmohan Singh today received five new blood vessels for his heart in a complex and high-risk surgical procedure that his doctors predicted would leave him even more active than he was before.

Paramedical staff wheeled Singh into an intensive care unit at the All India Institute of Medical Sciences (AIIMS) here at 8.55pm after a gruelling 11-hour coronary artery bypass surgery that had begun around 8am.

Doctors said a team from AIIMS and the Asian Heart Institute, Mumbai, had successfully grafted five new blood vessels to address five blockages in his arteries detected during diagnostic tests earlier this week.

“The Prime Minister is stable, conscious and he is responding to requests,” K. Srinath Reddy, a senior cardiologist and a member of the medical team involved in Singh’s diagnosis and treatment, said.

Singh will be kept under observation in intensive care for the next 48 hours. During this period, doctors will keep watch for signs of post-operative complications. The main risks are excessive bleeding from the incisions of the surgery and infection.

“We will be able to say he’s out of danger in about 48 hours,” a team member said as people in several parts of the country prayed for the Prime Minister’s speedy recovery.

This was Singh’s second bypass surgery — after a first bypass about 19 years ago. He had also undergone angioplasty to treat blockages in 2004. A repeat bypass is considered a relatively high-risk surgery.

“But bypass surgery was considered a better option for the long-term than angioplasty this time, because he had too many blockages,” said Ramakanta Panda, a cardiothoracic surgeon at the AHI who led the team that arrived from Mumbai.

Doctors began the surgery with an incision about seven inches long along the chest. After accessing the heart, they introduced five segments of new blood vessels. These new grafts will deliver blood to the heart, bypassing each of the five blockages.

Doctors expect Singh to be discharged in about eight days. “We believe that he will be able to attend to some official duties (from home) in about two weeks, and most of his official duties in about four weeks,” Reddy said.

The bypass will not leave Singh with any restrictions on his activities because the grafts address all blockages. “We expect him to be even more active after surgery (than before the procedure),” said Panda, an expert in repeat bypass and high-risk surgeries.

“One (possible) reason why the Prime Minister (may have) opted for immediate surgery was to be ready and fully active before the elections,” said Sampath Kumar, head of the cardiovascular surgery department at AIIMS.

“Panda works like a dedicated artist,” said a cardiologist in the team. “He joined the operation theatre after a single vegetable sandwich at 7am and didn’t leave the room for anything — anything — until after the surgery ended.”

Doctors say a repeat bypass usually takes eight hours or more — significantly longer than a first-time bypass. “We don’t look at the clock (during the surgery),” Panda said.

“The Prime Minister was stable throughout the procedure and there was no setback at any point during the surgery,” Reddy said.

The AIIMS-AHI team performed a beating-heart surgery — a procedure in which the grafts are introduced while the heart continues to beat. The procedure — the first such to be carried out in AIIMS — is technically challenging, but offers key advantages such as lower levels of blood loss and a lower risk of tissue injury.

SURGERY NUMBERS

PM wheeled into OT: 6.40am
Surgery begins: 8am
Surgery over: 7.30pm
Wheeled into ICU: 8.55pm

Bypasses (blockages removed): 5

Grafts

Total: 5
Blood vessels from where grafts were sourced
Mammary artery (chest): 1
Radial artery (left hand): 3
Vein (left leg): 1

YOUR QUESTIONS

• When can it be said medically that the PM is out of danger? About 48 hours after surgery

• Is it unusual that the surgery lasted more than 11 hours? No. Remember, it was a repeat (redo) surgery which raises the risk. In a first-time bypass surgery, surgeons take about 15 minutes to access the heart. But in a repeat bypass, getting to the heart takes longer — sometimes about two hours. The surgery itself is more complicated than a first-time bypass. Also, the doctors from Mumbai were working in an unfamiliar operation theatre. Doctors in similar circumstances prefer to work slow

• How many blockages were removed? Five, which can be categorised as a large number. It also means the PM would have been at considerable risk if the bypass was not carried out

• Where is the PM now? In the intensive care unit at AIIMS. After two to three days, he will be shifted to a room. A bypass patient could be discharged from hospital about seven to eight days after the surgery

• Has the PM regained consciousness? Doctors said at 10pm that the PM was already conscious but might take a couple of more hours to respond

• Will he be in pain? As any patient who has undergone a major surgery, the PM is likely to be under pain-relieving medication. But, doctors say, he is likely to experience some pain. Sedation will lessen pain to a large extent

• Can he speak? Yes. After he fully regains consciousness

• Will a family member be allowed to be with him? The PM may receive family members as visitors as early as tomorrow. But no family member was allowed into the intensive care unit on Saturday night.The intensive care unit will have nursing and paramedical staff round the clock

• What is the most critical factor now? Prevention of infection and post-operative bleeding. If fresh bleeding occurs, it is a worrisome factor and it has to be stopped through stitches. All vital parameters such as heart pumping action, blood flow and blood pressure will have to be monitored constantly with instruments