Dr. Prateek Bhatnagar Performs Successful High-Risk Total Arterial Beating Heart CABG in a Canadian Professor with Interstitial Lung Disease + 90% Left Main Stenosis + Diffuse Triple Vessel Disease

Dr. Prateek Bhatnagar operated on a 60-year-old gentleman from Montreal, Canada — a professor of business studies. He had developed unstable and rest angina. His medical history revealed interstitial lung disease (ILD) with a usual interstitial pneumonia (UIP) pattern and an FEV₁ of 45%. Coronary angiography showed 90% stenosis of the left main coronary artery, with diffusely diseased, small, and calcified vessels. His left ventricular function was normal.

Considering his poor lung function, a conventional bilateral internal mammary artery (BIMA) approach was avoided. Instead, Dr. Prateek Bhatnagar performed an off-pump coronary artery bypass graft (OPCAB) using a LIMA–Radial Y graft, which ensured good long-term flow while minimizing trauma. 5 grafts were placed: LIMA to LAD, and Radial Artery to Diagonal, Ramus, PLVB, and PDA arteries — all performed without using the heart-lung machine.

The patient was extubated just four hours after surgery and began early physiotherapy and pulmonary rehabilitation. He recovered smoothly and was discharged on the sixth postoperative day with excellent cardiac function. His postoperative 2D Echocardiogram showed an improved left ventricular ejection fraction (LVEF) of 62%.

This case demonstrates how early extubation, off-pump CABG and active pulmonary care can ensure excellent outcomes even in patients with severe ILD. Many international patients, especially from countries with long surgical waiting lists, travel to Hyderabad for such advanced, anaortic, off-pump coronary bypass procedures. Nearly 90% of our CABG patients receive BIMA grafts — customized for each individual’s clinical needs — ensuring long-term success with minimal risk.