Mumbai: 41-Year-Old Woman Undergoes City's First Trans-Axillary Double Valve Replacement At Hiranandani Hospital

Recently, a 41-year-old man from Andheri, who suffered from severe stenosis or narrowing of heart valves, got a new lease of life after undergoing trans-axillary double valve replacement, a first in the city.

The complex procedure, performed at Dr L H Hiranandani Hospital two weeks ago, involved replacing two heart valves with metallic prosthetic valves designed to last lifelong. While conventionally, the surgery is done by opening up the chest bone, in this case, it was done with a small cut below one of the arms.

Dr Swarup Pal, who did the surgery, said, “He came to our hospital a month ago, with complaints of dizziness and recurring breathlessness, while walking. He was not able to even take even a few steps.”

A 2D echo confirmed severe stenosis, said the doctor, adding that he also suffered from severe pulmonary hypertension (a type of high blood pressure that affects the arteries in the lungs). The patient asked if there is any other way other than the conventional sternotomy wherein the doctor cuts the breastbone to access the heart for valve replacement.

“The next approach was to make two incisions on the chest and do two small thoracotomies (surgical procedure to access chest cavity). However, we decided to proceed with a single cut, which would be hidden in the axillary crease or under the arm. This is called a trans-axillary thoracotomy, which is a difficult access incision,” said Dr Pal.

Generally, the surgery involves deflation of the lungs. However, this wasn't possible in this case as the man had severe lung adhesions (indication of damage due to injury or disease), said the doctor. He also ailed from severe calcification (calcium buildup in heart valves), which is rare, given his age, he added.

The surgery was successfully done using an innovative technology – peripheral bypass. After emptying the heart, the procedure was performed using sophisticated instruments, said Dr Pal, adding that this minimally invasive surgery will help in speedy recovery. “The patient has been discharged and doing well,” he said.

What is trans-axillary approach?

A type of minimally invasive surgery, trans-axillary approach involves replacing heart valves with one or two incisions under the arms. In medical terms, axillary means relating to the armpit.