Dr Vishal Khullar

Hypoplastic Left Heart Syndrome (HLHS): When the left side of the heart is severely underdeveloped and cannot pump enough blood to the body.

Transposition of the Great Arteries (TGA): A critical condition where the two main arteries leaving the heart are "switched," sending oxygen-poor blood to the body.

Tricuspid Atresia: When a missing heart valve prevents blood from flowing from the right atrium to the right ventricle, resulting in a "single ventricle" circulation.

Total Anomalous Pulmonary Venous Return (TAPVR): A defect where the veins bringing blood from the lungs attach to the wrong place in the heart.

Truncus Arteriosus: When a single large blood vessel stems from the heart instead of the separate aorta and pulmonary artery.

The Norwood Procedure (Stage 1 of 3): The first step in treating HLHS; the right ventricle is converted into the main pumping chamber, and the aorta is reconstructed to ensure the body receives blood.

Arterial Switch Operation (ASO): Performed for TGA; the aorta and pulmonary artery are disconnected and reattached to the correct ventricles, including the delicate transfer of coronary arteries.

The Fontan Procedure (Stage 3 of 3): The final stage for single-ventricle defects; oxygen-poor blood from the lower body is connected directly to the pulmonary artery, bypassing the heart.

The Glenn Procedure (Stage 2 of 3): Connects the large vein from the upper body (SVC) directly to the pulmonary artery to reduce the workload on a single working ventricle.

Ross Procedure: A sophisticated valve replacement where the patient’s own healthy pulmonary valve is moved to the aortic position, allowing it to grow as the child grows.

Median Sternotomy: Under general anesthesia, a midline incision is made through the breastbone to allow the surgical team full access to the heart and great vessels.

Advanced Cardiopulmonary Bypass: The patient is connected to a heart-lung machine designed to manage the tiny blood volumes of newborns while maintaining oxygenation to the brain and organs.

Deep Hypothermic Circulatory Arrest (DHCA): For the most intricate repairs, the body temperature is lowered to approximately 18°C, and circulation is briefly stopped to provide a still, bloodless field for the surgeon.

Anatomical Reconstruction: Using the patient's own tissue or synthetic patches (Dacron/Gore-Tex), the surgeon "re-plumbs" the heart, enlarging vessels and closing internal defects.

Coronary Re-implantation: In "switch" procedures, the tiny coronary arteries—often the size of a needle—are meticulously moved to the new aortic root to ensure the heart muscle receives blood.

Delayed Chest Closure: In some newborn cases, the chest is left "open" for 2–3 days with a sterile covering to allow the heart to recover from swelling before the final closure.

3D Anatomical Modeling: Surgeons often use 3D-printed models of the patient's specific heart anatomy to "rehearse" and plan the complex reconstruction before surgery.

Prostaglandin Infusion: Many newborns are kept on a continuous IV medication (Alprostadil) to keep the ductus arteriosus open, ensuring survival until surgery can be performed.

Nutritional Optimization: Infants may require specialized high-calorie feeding or TPN (IV nutrition) to reach a stable weight and strength for the operation.

Cardiac Catheterization: A detailed study to measure internal heart pressures and resistance in the lung vessels, which is critical for planning "staged" procedures.

Fasting (NPO): Strict adherence to fasting guidelines is required to ensure safety during the induction of general anesthesia.

Fetal and Neonatal Echocardiogram: The primary diagnostic tool used to visualize the internal structures of the heart and the origin of the great vessels.

Cardiac MRI or CT: Provides high-resolution, three-dimensional images of the heart's relationship to the lungs and chest wall.

Genetic Screening: To check for associated syndromes (such as DiGeorge Syndrome) that may impact the child's overall surgical risk and recovery.

Cross-match Blood Work: Because these surgeries involve significant blood volumes, several units of specifically typed and screened blood are prepared in advance.

Cardiac ICU (CICU): Patients spend 7 to 21 days in a specialized ICU where heart function, rhythm, and oxygen levels are monitored second-by-second.

Inotropic Support: High doses of IV medications are often used for several days to help the "re-plumbed" heart pump effectively as it adapts to the new circulation.

Neurological Monitoring: Given the use of bypass and circulatory arrest, the medical team closely monitors for seizures or developmental milestones during recovery.

Wound and Bone Healing: For children, the breastbone typically heals within 6 to 8 weeks; parents are taught specific "lifting" techniques to protect the chest.

Lifelong CHD Specialist Care: These patients are considered "repaired" rather than "cured" and require lifelong surveillance to monitor for valve issues or rhythm changes.

Life-Saving Intervention: Provides a definitive chance at survival for infants born with defects that would otherwise be fatal within days or weeks.

Improved Oxygenation: Corrects "cyanosis" (blueness), allowing the child’s brain and organs to receive the oxygen necessary for normal development.

Restores Physical Potential: Many children grow up to lead active lives, attend school, and participate in sports that would have been impossible without repair.

Growth and Development: Relieving the heart's workload allows the body to redirect energy toward physical growth and cognitive milestones.

Staged Success: The multi-stage approach (Norwood/Glenn/Fontan) allows the heart to grow and the lungs to mature, leading to better long-term outcomes in single-ventricle patients.

Left Main Disease: A severe blockage in the main artery supplying the left side of the heart, which is considered high-risk.

Triple Vessel Disease: Significant blockages in all three major coronary arteries.

Diabetes: Patients with diabetes and multi-vessel disease often have better long-term outcomes with surgery than with stenting.

Complex Anatomy: Blockages that are too long, heavily calcified (hardened), or located in areas where a stent cannot be safely placed.

Failed Angioplasty: When previous attempts to open arteries with balloons or stents have not been successful or the artery has narrowed again.

On-Pump CABG: The traditional method where a heart-lung bypass machine takes over the work of the heart and lungs, allowing the surgeon to operate on a still, non-beating heart.

Off-Pump (Beating Heart) CABG: The surgeon uses specialized stabilizers to operate while the heart continues to beat, avoiding the bypass machine. This is often preferred for patients at high risk for stroke.

Minimally Invasive (MIDCAB): Small incisions are made between the ribs rather than through the breastbone. This is typically used for bypassing one or two arteries on the front of the heart.

Endoscopic Vessel Harvesting (EVH): A 2026 standard where grafts from the leg or arm are removed through tiny incisions using a camera, reducing scarring and pain.

Incision: A midline incision is made, and the breastbone (sternum) is divided to access the heart.

Harvesting: Simultaneously, healthy vessels are harvested: the Internal Mammary Artery (chest), Saphenous Vein (leg), or Radial Artery (arm).

Bypass: One end of the graft is attached to the aorta (the main artery) and the other end below the blockage, creating a permanent "detour."

Restarting: Once the connections are tested for leaks, the heart is restarted (if it was stopped), and the bypass machine is disconnected.

Closing: The sternum is secured with permanent stainless steel wires, and the skin is closed with stitches or staples.

Fasting for at least 8–12 hours before surgery, as it is performed under general anesthesia.

Extensive blood work, chest X-rays, and an ECG to ensure you are fit for major surgery.

Dental clearance is often required to ensure no hidden infections could travel to the heart.

Stopping or adjusting certain medications, especially blood thinners like Clopidogrel or Aspirin, as directed.

Shaving and surgical scrubbing of the chest, legs, and arms to prevent infection.

Coronary Angiogram: The "roadmap" that shows exactly where the blockages are located.

Echocardiogram: To assess the heart's pumping strength (Ejection Fraction) and valve function.

Carotid Doppler: To check for blockages in the neck arteries that might increase the risk of stroke during surgery.

Pulmonary Function Test (PFT): To ensure the lungs are strong enough to handle anesthesia and recovery.

Vein Mapping: Ultrasound of the legs or arms to ensure the vessels are healthy enough to be used as grafts.

ICU Stay: Expect to spend the first 24 hours in the Intensive Care Unit for close monitoring of heart rhythm and blood pressure.

Hospital Stay: Total recovery in the hospital usually lasts 5 to 7 days.

Sternal Precautions: For the first 6 weeks, you must avoid lifting anything heavier than 2–3 kg to allow the breastbone to heal properly.

Cardiac Rehabilitation: Starting around week 6, supervised exercise programs are highly recommended to rebuild strength.

Long-term Meds: You will likely remain on Aspirin and cholesterol-lowering medications (statins) indefinitely to keep the new grafts clear.

Superior Longevity: Provides a long-term solution for complex multi-vessel disease, often outlasting stents.

Symptom Relief: Significant reduction or total elimination of chest pain (angina) and shortness of breath.

Reduced Heart Attack Risk: By restoring blood flow to large areas of the heart, the risk of a future major cardiac event is lowered.

Improved Quality of Life: Most patients return to an active lifestyle and can exercise more effectively than before surgery.

2026 Success Rates: Elective CABG has a high survival rate (approx. 98–99%) due to advanced surgical and anesthesia protocols.

Severe heart failure not improving with medicines or procedures

Frequent hospital admissions due to worsening heart condition

Extreme fatigue, weakness, or breathlessness during simple tasks

Swelling in legs, ankles, or abdomen because of fluid buildup

Life-threatening arrhythmias that cannot be controlled

Poor heart pumping capacity despite advanced treatment

Dilated or restrictive cardiomyopathy

Severe coronary artery disease with repeated heart attacks

Congenital heart defects not treatable with surgery

End-stage valvular heart disease

Severe myocarditis causing permanent heart damage

Heart failure after previous surgeries or device implants

General anesthesia is given for complete comfort

The weakened or failing heart is surgically removed

A healthy donor heart is connected to major blood vessels

The new heart is started carefully to ensure proper function

Monitoring lines and drains are placed for recovery

You are shifted to the ICU for close observation

Heart function tests and blood/tissue matching

Follow all fasting and medication-related instructions

Maintain controlled blood pressure, blood sugar, and healthy weight

Avoid alcohol and stop smoking at least 3–4 weeks before surgery

Attend counseling to prepare mentally and physically

ECG to check heart rhythm

Echocardiography to assess pumping capacity

CT or MRI scans for detailed imaging

Pulmonary function tests for lung strength

Blood typing and tissue matching

Coronary angiography, if required

ICU stay: usually 3–5 days

Hospital recovery: around 2–3 weeks

Regular follow-ups to monitor organ acceptance

Anti-rejection medicines taken lifelong

Gradual return to daily activities in 8–12 weeks

Healthy diet, low-salt meals, and light exercise

Cardiac rehabilitation for long-term recovery

Better heart function and improved blood flow

Relief from breathlessness, fatigue, and swelling

Fewer hospital visits and emergency episodes

Better stamina and improved quality of life

Long-term survival with the right care and medicines

End-Stage COPD (Emphysema): When chronic obstructive pulmonary disease has caused such severe damage that breathing is difficult even with supplemental oxygen.

Idiopathic Pulmonary Fibrosis: Progressive scarring of the lung tissue that prevents the lungs from transferring oxygen into the bloodstream.

Cystic Fibrosis: A genetic condition causing thick, sticky mucus to build up in the lungs, leading to repeated, life-threatening infections.

Pulmonary Hypertension: High blood pressure in the arteries of the lungs that can eventually lead to right-sided heart failure.

Alpha-1 Antitrypsin Deficiency: A genetic disorder that can cause severe lung and liver disease.

Single Lung Transplant: Replaces one damaged lung. This is often used for certain restrictive diseases like pulmonary fibrosis.

Double (Bilateral) Lung Transplant: Replaces both lungs simultaneously. This is the primary choice for infectious diseases like cystic fibrosis to ensure no infected tissue remains.

Heart-Lung Transplant: A rare procedure that replaces the heart and both lungs, usually for patients with severe pulmonary hypertension and concomitant heart failure.

Anesthesia: The procedure is highly complex and performed under general anesthesia.

Duration: A single transplant usually takes 4 to 8 hours, while a double transplant can take 6 to 12 hours.

Incision: For a single lung, an incision (thoracotomy) is made on the side of the chest. For a double lung, a horizontal "clamshell" incision is often made across the chest.

Support: During the surgery, you may be connected to a heart-lung bypass machine or ECMO (Extracorporeal Membrane Oxygenation) to circulate blood and oxygen.

Connection: Surgeons meticulously sew the new lung's main airway (bronchus) and major blood vessels (pulmonary artery and veins) to your own.

Transplant Evaluation: An extensive series of tests to ensure you are healthy enough for surgery and committed to a lifelong post-transplant regimen.

Psychological Assessment: To evaluate your support system and ability to manage complex medication schedules.

Pulmonary Rehab: Engaging in specialized exercise to keep your body as strong as possible while waiting for a donor match.

Vaccinations: Ensuring all immunizations are up to date, as your immune system will be suppressed after surgery.

The Waiting List: Once approved, you are placed on a national registry where donor lungs are matched based on blood type, organ size, and geographic distance.

Pulmonary Function Tests (PFTs): To measure exactly how much air your lungs can hold and how well they move gases.

Cardiac Catheterization: To check the pressure in your lung arteries and the overall strength of your heart.

Chest CT Scan: Providing high-resolution 3D images of your lung structure and chest cavity.

Tissue Typing: Matching your tissue markers with potential donors to reduce the risk of immediate organ rejection.

ECG and Stress Test: Ensuring your heart can withstand the rigors of a multi-hour major surgery.

Hospital Stay: Typically 1 to 3 weeks, with the first several days spent in the Intensive Care Unit (ICU) on a mechanical ventilator.

Lifelong Medication: You must take immunosuppressant (anti-rejection) drugs for the rest of your life to prevent your body from attacking the new lung.

Monitoring: Frequent follow-up visits, blood tests, and bronchoscopies (using a camera to look inside the lungs) are required, especially in the first year.

Physical Rehab: You will start walking within days of surgery and gradually progress to light exercise over 6 to 8 weeks.

Lifestyle Adjustments: Avoiding crowds during flu season, wearing masks in certain environments, and strict food safety are necessary to prevent infections.

Significant Survival Benefit: For many patients with end-stage disease, a transplant can extend life expectancy by many years.

Restored Breathing: Patients often transition from being housebound on oxygen to walking, traveling, and engaging in physical hobbies.

Advanced Surgical Support: The use of ECMO technology allows surgeons to perform transplants on the most critically ill patients with greater safety.

Comprehensive Care Teams: Post-transplant care involves a dedicated team of pulmonologists, surgeons, pharmacists, and coordinators to manage every aspect of recovery.

Improved Quality of Life: Beyond just survival, a successful transplant provides the "gift of breath," allowing for a return to a much more normal and active lifestyle.

Elderly Patients (70+ years): Those who may be more vulnerable to the systemic physiological stress of a heart-lung machine.

History of Stroke: Patients with a "porcelain" (heavily calcified) aorta where clamping the vessel during traditional surgery increases the risk of a stroke.

Chronic Kidney Disease: Maintaining natural blood pressure and pulsatile flow during surgery is generally safer for renal function.

Liver Disease or Blood Disorders: Patients who may face higher complications from the intense blood-thinning required for "on-pump" machines.

Lung Issues: Those with respiratory compromise who benefit from being taken off a ventilator as quickly as possible following the procedure.

Suction Stabilizers: Small, mechanical arms that "grip" a tiny area (1–2 cm) of the heart surface, keeping that specific spot perfectly still while the rest of the heart continues to pump.

Intracoronary Shunts: Tiny plastic tubes inserted into the artery during the stitching process to ensure blood continues to flow to the heart muscle while the surgeon sews the graft.

Heart Positioners: Suction devices used to gently lift and rotate the beating heart, allowing the surgeon to reach blockages on the side or back walls.

Transit Time Flow Measurement (TTFM): A clinical standard used during surgery to verify that blood flow through the new graft is perfect before closing the chest.

Deep Pericardial Stay Sutures: Specialized internal stitches that allow the surgeon to maneuver the heart safely into the necessary positions without stopping it.

Surgical Access: Under general anesthesia, a standard midline incision is made through the breastbone (sternotomy) to reach the heart.

Graft Harvesting: Healthy vessels are prepared from the chest (internal mammary artery), leg (saphenous vein), or arm (radial artery) to be used as the new bypass routes.

Heart Positioning: The surgeon carefully maneuvers the beating heart using positioners to expose the specific blocked coronary arteries.

The Bypass: The stabilizer is applied to the target site, and the surgeon meticulously sews the graft onto the artery using ultra-fine sutures.

Verification & Closing: After confirming flow with TTFM, the stabilizer is removed, and the breastbone is secured with permanent stainless steel wires.

Fasting (NPO): No food or drink for at least 8–12 hours before surgery to ensure safety during general anesthesia.

Baseline Diagnostics: Extensive blood tests, chest X-rays, and an ECG to assess overall surgical readiness and organ function.

Dental Clearance: A check to rule out any active oral infections that could travel through the bloodstream and compromise the heart surgery.

Medication Adjustment: Reviewing all prescriptions; anti-platelet drugs or blood thinners may need to be paused or adjusted several days prior.

Surgical Scrub: Shaving and antiseptic scrubbing of the chest and any potential graft harvest sites on the legs or arms.

Coronary Angiogram: The essential "roadmap" that identifies the exact location and severity of blockages for the surgical team.

Echocardiogram: An ultrasound to evaluate the heart's pumping strength and identify any underlying valve issues.

Carotid Ultrasound: To assess stroke risk by checking the health of the arteries supplying blood to the brain.

CT Scan of the Aorta: Specifically used to check for heavy calcification (porcelain aorta) that would favor an off-pump approach.

Vein/Artery Mapping: Ultrasound imaging to ensure the quality and size of the blood vessels intended for use as bypass grafts.

ICU Recovery: Patients typically spend the first 12 to 24 hours in the Intensive Care Unit for close hemodynamic monitoring.

Hospital Discharge: The total stay is usually 4 to 5 days, which is often 1–2 days shorter than traditional "on-pump" bypass surgery.

Sternal Precautions: To allow the breastbone to heal, patients must avoid lifting anything heavier than 2–3 kg (about 5 lbs) for 6 to 8 weeks.

Gradual Recovery: Most patients return to light daily activity quickly but require 2 to 3 months for a full return to strenuous levels.

Cardiac Rehab: Participating in a supervised exercise and education program starting around week 6 is vital for long-term cardiovascular health.

Reduced Stroke Risk: Avoiding the clamping of a calcified aorta minimizes the chance of dislodging plaque that could travel to the brain.

Organ Protection: Shorter ventilator times and more natural, pulsatile blood flow help protect the sensitive kidney and lung systems.

Less Bleeding: Beating heart surgery generally requires fewer blood transfusions than procedures involving a bypass machine.

Lower Inflammatory Response: Avoiding the heart-lung machine reduces the "whole-body" inflammation often seen after major cardiac surgery.

Faster Return to Normalcy: Many patients experience shorter hospital stays and a quicker initial recovery phase compared to traditional methods.