52-year-old Pune Man Survives Fourth Major Heart Surgery with Complex Bentall Procedure: Exploring The Surgery

One open-heart surgery is considered a life-changing event. For most patients, even a single operation carries immense risks. But for 52-year-old Pune businessman Prashant Chandrkant Zalke, life had a different challenge in store. Over two decades, he underwent not one, not two, but four major heart surgeries, the latest being a highly complex Bentall procedure. 

This rare surgery lasted 11 hours, with the patient connected to a heart-lung machine for seven. His survival is nothing short of a medical milestone and a story worth telling. To get more insights on the surgery, Dr Sameer Bhate, Senior Consultant and Head of Adult Cardiac Surgery at Amrita Hospital, Faridabad, explained his cardiac journey and what ultimately saved his life. 

A Two-Decade-Long Cardiac Journey

Prashant has suffered from heart disease since 2002, when he was diagnosed with rheumatic heart disease. It has damaged his mitral and aortic valves. His heart was failing at that time because of valve leakage. At Pune, doctors substituted both valves with tissue biological valves. He chose them due to the fact that tissue valves do not need blood thinners throughout their life as compared to the mechanical ones.

Detailing the case, Dr Bhate explains that tissue valves don’t last forever. “A decade later, in 2012, the valves degenerated and had to be replaced again. In 2022, he faced yet another surgery, this time to replace his mitral valve with a mechanical valve due to atrial fibrillation, which required him to take blood thinners,” he shared

However, his condition deteriorated once again in December 2024. This time, the valve of the aorta failed, and he was breathless and exhausted. Fourth surgery was inevitable. Most doctors in Pune refused to do the surgery as they thought that it was too risky.

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“I Was Told I Might Not Survive”

For Prashant, the situation was terrifying. “Several doctors in Pune declined to operate, citing the high risk,” he recalled. “I was told I might not survive a fourth surgery. But by God’s grace, I got a second chance at life. I’m deeply grateful.” However, it was a unique surgery which came as a rescue for him. 

What Is a Bentall Procedure?

His case was eventually taken up by Dr Sameer Bhate, who believed the surgery could be performed successfully. According to Dr Bhate, “The Bentall procedure is one of the most complex heart operations. It involves replacing the aortic valve, the ascending aorta, and reimplanting the coronary arteries into a new graft. Precision is crucial, and in repeat surgeries, it becomes even harder because of scarring and weak tissues. Every step must be done carefully, as there is little room for error.”

For Prashant, what was initially planned as an aortic valve replacement had to be converted into a full Bentall procedure because of the extent of damage discovered during surgery.

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Why the Fourth Surgery Was So Complex

Dr Bhate explains that redo heart surgeries are always high-risk. “Repeat surgery is more complex due to scar tissue, distorted anatomy, and weak hearts. However, the fourth surgery is very uncommon and very difficult,” he shared. 

Some of the hurdles faced by Dr Bhate during this operation included:

• Dissection is dangerous due to severe scarring from three prior surgeries.
• Unfriendly anatomy, which rendered the conventional bypass access difficult. 
• Because of the scar tissue and changes inside his chest from earlier surgeries, the surgeons couldn’t connect the heart-lung machine the usual way. 
• So, they had to use arteries and veins in his belly (abdomen) to help keep his blood flowing during the operation.
• The tearing of the coronary artery during the operation had to be quickly handled with a bypass graft.
• The decision was made to leave the chest open and carefully pack it for 24 hours to control bleeding before closing it the next day.

Why Did His Valves Keep Failing?

Dr Bhate explains that valve replacements save lives but are not permanent solutions. Below are a few pointers explaining why the valves kept failing for Prashant.

• Heart valves that are made from animal tissue usually work well for 10–15 years, but over time, they wear out and need to be replaced. 
• On the other hand, mechanical valves are built to last much longer, but people who have them need to take blood-thinning medicines for life.
• In Prashant’s case, his first two surgeries used tissue valves, which eventually wore out. By 2022, doctors had to replace his mitral valve with a mechanical one. 
• However, the tissue valve in his aortic position failed again just two years later. Each time a valve wore out, the next surgery became more difficult than the one before.

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Hours on the Operating Table

The fourth surgery stretched to 11 hours, with the patient cooled to 28°C to protect his brain and vital organs, shared Dr Bhate. Prashant remained on cardiopulmonary bypass (heart-lung machine) for seven hours. The surgical team had to improvise at multiple stages, showcasing both expertise and courage.