Bad Sickle Cell Disease & Successful Aortic Valve Replacement By Dr. Prateek Bhatnagar

Performing cardiac surgery in patients with sickle cell disease presents significant challenges due to the risk of sickling crisis, organ complications, and high perioperative mortality. Careful preparation and meticulous intraoperative management are essential for a successful outcome.

Recently, Dr. Prateek Bhatnagar operated on a 42-year-old gentleman diagnosed with severe aortic stenosis. The patient was a known case of sickle cell disease, with hemoglobin electrophoresis showing HbS at 63%. His medical history was notable for autosplenectomy, an ischemic cerebrovascular accident in 2022, and bilateral avascular necrosis of the femoral heads. Just a month prior to surgery, he had been hospitalized for a sickle cell crisis and acute abdomen, further emphasizing the complexity of his case.

A 2D Echocardiogram revealed severe aortic stenosis with associated aortic regurgitation, and clinically, he was in NYHA Class III, experiencing marked limitation of physical activity. Given the high risk, Dr. Bhatnagar initiated a detailed preoperative optimization protocol. For three weeks prior to admission, the patient was maintained on hydroxyurea and sodium bicarbonate, along with oxygen therapy at 1L/min to prevent hypoxia-induced sickling.

On the morning of surgery, a 1.5-liter exchange transfusion was performed, effectively reducing his HbS levels to 30.2%. Later that afternoon, Dr. Bhatnagar performed the aortic valve replacement under warm heart surgery conditions, using a 19mm mechanical aortic valve. Throughout the surgery and postoperative period, sodium bicarbonate infusion, hydroxyurea therapy, optimal oxygenation, and good hydration were meticulously maintained to prevent any sickling episodes.

The patient made an excellent recovery. By the sixth postoperative day, he was mobilizing independently and even climbing stairs. He was subsequently discharged in stable condition with a well-functioning mechanical aortic valve and no postoperative complications.

This case underscores the importance of individualized preoperative preparation, intraoperative vigilance, and postoperative care in managing patients with sickle cell disease undergoing cardiac surgery. Despite the inherent risks associated with high HbS levels and previous crises, successful outcomes are achievable through a carefully coordinated, multidisciplinary approach.

Dr. Prateek Bhatnagar is a renowned Cardiac Surgeon with extensive experience in complex coronary artery bypass surgeries (including Total Arterial and BIMA CABG), valve replacements, and redo cardiac surgeries. He is known for his expertise in managing high-risk cardiac patients, innovative surgical techniques, and his meticulous attention to perioperative care.  With thousands of successful cardiac procedures to his credit, Dr. Bhatnagar continues to advance excellence and innovation in the field of cardiac surgery, ensuring safer and more effective outcomes even in the most challenging cases.