54-year-old man with rare bleeding disorder and coronary artery disease successfully underwent a lifesaving surgery at Fortis Hospital, Bann

Bengaluru, June 08, 2022: In a rare case, a 54-year-old man with a rare bleeding disorder (RBD) and Triple Vessel Coronary Artery disease successfully underwent a life-saving procedure at Fortis Hospital, Bannerghatta Road, Bengaluru. The team of doctors was led by Dr Vivek Jawali- Chairman-Cardiac Sciences and Chief-Cardio Vascular Thoracic Surgery- Fortis Hospitals, Bangalore along with Dr Niti Raizada-Director- Medical Oncology &Hemato-Oncology, Fortis Hospital, Bannerghatta Road and Dr. Girish V Badarkhe- Senior Consultant- Haemato Oncology & BMT- Fortis Hospital, Bannerghatta Road.

The Patient had a history of Ischemic Heart disease and was witnessing breathlessness for the past two months. He had undergone Coronary Angiogram at a private hospital in the month of March and was diagnosed to have triple vessel coronary artery disease. He had visited Fortis Hospital, Bannerghatta Road for further management of his medical condition. After a thorough examination, he was advised to undergo Coronary Artery Bypass Surgery (CABG). During the evaluation, it was also found out that he is a known case of Congenital factor VII (FVII) deficiency for which Dr Niti Raizada and Dr. Girish V Badarkhe were consulted.

The patient was suffering from multiple co-morbidities - Congenital factor VII (FVII) deficiency alongwith triple vessel coronary artery disease. Congenital Factor VII is a rare genetic bleeding disorder - a condition which is characterized by a deficiency or reduced activity of clotting factor VII. Clottingfactors are specialized proteins that are essential for the blood to clot normally. They are crucial to plug the site of a wound to stop bleeding during any medical procedure. Individuals with factor VII deficiency can experience prolonged, uncontrolled bleeding episodes during and post-surgery. Triple Vessel Coronary Artery Disease (CAD) is an extreme form of CAD that causes blockage in the blood vessels, and the patient might require a bypass surgery to maintain his quality of life.

Dr Vivek Jawali- Chairman-Cardiac Sciences-Chief of Cardio-Thoracic Vascular Sciences, Fortis Hospitals, Bangalore, explains, “This patient was suffering from triple vessel disease, as the name implies, three major blood vessels that supply blood to the heart were getting impacted as compared to most coronary artery disease which may only significantly impact one of the major coronary arteries. We decided to conduct an urgent bypass surgery for him as any further delay in the treatment would have led to heart failure. However, considering his bleeding disorder, we did a proper workup and consulted a team of hematologists as he was at a high risk of developing preoperative bleeding and post-operative blood clots.

Fortunately, his condition was stable during and post-surgery and we did not witness any sort of bleeding risk or other health complications. The patient was monitored for over 2days’ post which the patient was discharged in a stable condition.”

Dr Niti Raizada, Director, Medical Oncology &Hemato-Oncologyand Dr. Girish V Badarkhe- Senior Consultant- Haemato Oncology &BMT,Fortis Hospital, Bannerghatta Road, Bangalore, explains,“Though rare, a deficiency of FVII may cause life-threatening bleeding in the perioperative and postoperative periods. On admission, the patient was given an adequate dose of Factor VII (Recombinant FVII)to maintain intra operative FVII level >50%. With initial dosing, we were able to maintain an adequate FVII level. We had to rigorously monitor the FVII level and ROTEM(check on blood clots) to guide us for RFVII dosing. It was a tough situation to keep the patient’s graft patent and avoid any kind of thrombosis with minimizing bleeding risk”.

As per a study, Ischaemic heart disease (IHD) has been reported as an important cause of morbidity and mortality in patients with Factor VII deficiency. For each RBD patient undergoing CV procedure, the perioperative care team needs to develop an individualized plan for surgery and concurrent factor replacement strategy. Balancing bleeding risk during the surgery and risks of thrombotic events post-surgery in patients with bleeding disorders is difficult and requires a multidisciplinary approach.

About Fortis Healthcare Limited

Fortis Healthcare Limited – an IHH Healthcare Berhad Company – is a leading integrated healthcare services provider in India. It is one of the largest healthcare organizations in the country with 27 healthcare facilities (including projects under development), 4100 operational beds and over 419 diagnostics centres (including JVs). Fortis is present in India, United Arab Emirates (UAE) & Sri Lanka. The Company is listed on the BSE Ltd and National Stock Exchange (NSE) of India. It draws strength from its partnership with global major and parent company, IHH, to build upon its culture of world-class patient care and superlative clinical excellence. Fortis employs 23,000 people (including SRL) who share its vision of becoming the world’s most trusted healthcare network. Fortis offers a full spectrum of integrated healthcare services ranging from clinics to quaternary care facilities and a wide range of ancillary services