The Telegraph
Since 1st March, 1999
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Artery-to-artery graft boon for soccer coach

Amal Dutta, of “fluid diamond” fame, will be fit to kick a football in a few weeks. The veteran coach was discharged from Apollo Gleneagles Hospitals on Tuesday, a week after a bypass surgery for acute unstable angina.

“I am feeling better than ever before and can’t wait to get back to action on the pitch with my wards,” said Dutta, with a demonstrative quick-jog down the hospital corridor. Dutta, who had rekindled Calcutta’s dwindling passion for the game late last decade with his attractive brand of soccer in Mohun Bagan colours, has reasons to feel buoyant.

Unlike in routine CABG (coronary artery bypass grafting), his bypass surgery was done on a beating heart using a single incision on his chest. Three grafts were sutured in place, covering all areas of the heart, and most important, sparing his legs. The usual practice is to take veins from the leg and use them for the artery grafts. “But the leg wound often takes a long time to heal and the patient’s mobility is severely hampered. Considering his (Dutta’s) vocation, we did a different procedure on him, entailing just one cut on the chest, thus saving his golden legs from injury,” explained Ramesh Sheshadhri, director, cardiovascular surgery, Apollo Gleneagles.

In the Rima-Lima Y technique used to treat Dutta’s left-main disease, both the left internal mammary artery (Lima) and the right internal mammary artery (Rima) were taken to create a Y formation to bypass all the blocked arteries.

“Unlike the more common vein-to-artery process, this is artery-to-artery, which is a much happier option, since veins are structurally and functionally not suited to match with arteries. Besides, size and quality of veins are not standardised and vary from individual to individual,” said Sheshadhri, who has now done close to 100 such cases in the city.

Apart from the single incision, which spares the limbs, chances of recurring problems are much less in the Rima-Lima Y technique than in vein grafts. “Of course, it is technically more demanding and the margin for error is minimal,” he observed. Over a period of eight to 10 years, around 50-60 per cent of patients would have their vein grafts occluded, thus needing redo surgery or angioplasty.

“This is because veins are from a low-pressure system and not used to a high-pressure environment, where those are grafted,” said Sheshadhri. But Rima-Lima surgeries, which come for the same package cost as a regular CABG, have a longer success rate.

The artery-to-artery grafting technique could also be a boon for high-risk groups like diabetics, obese individuals or those with high cholesterol, for whom a leg wound can be “a really vexatious” issue.

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