New Delhi [India], May 21 : A private hospital in Delhi has successfully saved the lives of two critically ill patients who were battling advanced liver failure compounded with a serious cardiac ailment - a combination considered exceptionally high risk and often fatal.
The successful execution of combined liver transplantation and complex cardiac surgeries in such patients remains extremely rare globally, with only a handful of such cases reported in medical literature, particularly among those with advanced liver disease. Historically, isolated cardiac procedures in patients with severe cirrhosis have been associated with very poor clinical outcomes, underscoring the extraordinary nature and clinical significance of these successful interventions.
Both patients had been living with decompensated chronic liver disease - an advanced stage of liver failure that causes severe complications such as fluid accumulation in the abdomen, altered consciousness, bleeding from the food pipe, jaundice, and kidney dysfunction.
Their condition had reached a stage where liver transplantation was the only life-saving option. However, during pre-transplant evaluation, the team of doctors discovered serious underlying heart conditions in both patients - making liver transplantation unsafe, unless the cardiac issues were addressed first.
The first patient, aged 46 years and a resident of Kashkadarya (Uzbekistan) was diagnosed with severe blockages in all three major heart arteries.
The second patient, aged 41 years, suffered from critical narrowing of the heart valve that controls blood flow from the heart to the body. Either condition alone can be fatal if not treated on time.
Recognising that treating only one organ would not improve survival outcomes, the medical teams designed individualised, integrated treatment plans to address both heart and liver conditions in a carefully coordinated manner.
For the first patient, surgeons performed a coronary artery bypass on the beating heart, a specialised approach chosen to minimise bleeding risks in the setting of advanced liver disease. This was immediately followed by a living-donor liver transplant during the same operative session, ensuring a seamless transition between procedures. In the case of the second patient, the team first performed open-heart surgery to replace the diseased heart valve. After vigilant monitoring for 24 hours to rule out complications such as stroke, the team proceeded with a living-donor liver transplant the next day.
Each of these highly complex surgeries lasted several hours and required meticulous surgical planning, advanced anaesthesia support, and continuous round-the-clock intensive care monitoring. Despite the inherent challenges - including the high bleeding risk associated with liver failure - the teams effectively managed blood loss with minimal blood transfusions. Both patients recovered steadily after their procedures and were discharged in stable condition within three weeks, with well-functioning transplanted livers and stable cardiac function, a notable achievement given the complexity and rare nature of such combined interventions
Dr Ashish George, Principal Consultant & Unit Head - Liver Transplant and HPB Surgery, Fortis Hospital, Shalimar Bagh, said, "Delaying surgery in these patients was not an option given the severity of their liver failure and cardiac conditions. The success of the clinical interventions depended on precise timing, selection of appropriate surgical techniques, and seamless collaboration across multiple specialities. These cases underscore that even patients once deemed inoperable can be successfully treated when backed by the right expertise, medical infrastructure, and coordinated multi-disciplinary care."
The Cardiology team, Fortis Shalimar Bagh, said, "Both of these patients presented with critical cardiac ailment, which itself is an indication of critical cardiac surgery, but along with advanced liver disease requiring liver transplant, was a very complex scenario. The first patient had critical triple vessel disease with two vessels having 100% disease and one artery having 99% disease, for which he underwent OPCABG. The second patient had severe aortic stenosis with left ventricular dysfunction for which he underwent mechanical aortic valve replacement. Great outcomes in these complex diseases are an outcome of great teamwork among super specialities, expertise for dealing with these complex diseases and infrastructure."
Naveen Sharma, Facility Director, Fortis Hospital, Shalimar Bagh, said, "These rare and complex cases highlight Fortis' expertise in managing multi-organ failure through close collaboration between liver transplant surgeons, cardiac surgeons, anesthesiologists, and critical care teams. These landmark successes reinforce Fortis Shalimar Bagh's role as a leading centre for advanced liver transplantation and complex cardiac care, offering new hope to patients with multiple life-threatening conditions through integrated, patient-focused treatment."
Worldwide, the combination of liver transplantation and cardiac surgery remains an exceptionally rare and highly complex intervention, with only a limited number of such cases reported globally due to the significant surgical risks and specialised multidisciplinary expertise required.