Heart beats on: 74-year-old survives landmark open-heart surgery at KNH

Surgeons perform coronary artery bypass surgery at Kenyatta National Hospital in Nairobi on September 23, 2026. [Benard Orwongo, Standard]

At 8.06 am, the doors of the main theatre at Kenyatta National Hospital in Nairobi swung open and a 74-year-old man was wheeled in for a life-saving operation.

He was received by Prof Hiroshi Ninami, a Japanese cardiac surgeon, and a team of 14 specialists ready to perform a delicate and advanced procedure.

Unlike conventional coronary artery bypass surgery, in which a heart-lung machine is used to keep blood circulating while the heart is stopped, Prof Ninami and his team would perform the open-heart operation using an off-pump technique, allowing the heart to continue beating.

The patient had suffered a myocardial infarction, commonly known as a heart attack, which occurs when blood flow to part of the heart muscle is blocked, causing tissue damage.

Tests conducted at KNH showed that three major coronary vessels were diseased and blocked. Other major vessels branching into arteries supplying blood to the heart were also affected.

After assessment, doctors determined that the patient required multiple bypass grafts.

At the operating table, Prof Ninami guided the team as surgeons harvested blood vessels from the patient's chest and leg to create new routes for blood to flow around the blocked arteries.

The procedure, known as coronary artery bypass grafting (CABG), was underway.

The patient had a history of a weak heart and chest pains, and doctors said about half of his heart muscle had been damaged.

Throughout the operation, his heart could be seen beating.

Five hours later, the multidisciplinary team joined hands in celebration. The surgery had been successful.

The 74-year-old was among 10 patients undergoing planned cardiac surgeries at KNH using off-pump technology, the first such procedures at the hospital and, according to the team, the first of their kind in Kenya and East and Central Africa.

“We have done four grafts on the patient. Actually, the patient had three diseased vessels. These vessels also needed branches that were worked on,” explained Prof Ninami.

“I did four grafts with an internal mammary artery and a saphenous vein taken from the leg,” added Prof Ninami, a cardiac surgeon specialising in heart bypass procedures.

In an interview with The Standard, Prof Ninami said the myocardial infarction could have been fatal.

When a patient suffers a heart attack, blood flow to the area supplied by the affected vessel is greatly reduced, damaging the heart muscle.

The blockage can occur suddenly, leaving a patient in need of emergency treatment. In some cases, however, the damage may be too extensive, resulting in death.

Dr Simon Ndiritu, head of the cardiology unit at KNH and part of the surgical team, explained that doctors use a patient's own tissues and blood vessels to create the bypasses.

Doctors can use either arteries or veins, although arteries are generally preferred because they carry blood under higher pressure and tend to remain open for longer.

“We have some of the arteries from the patient's own body, especially the ones in the chest, just behind the breastbone, because they are close to the heart,” said Dr Ndiritu.

He added: “But in our patient, there will not be enough because there are multiple places that need to be grafted.”

In this case, doctors harvested a long vein from the patient's leg to supplement the arterial grafts.

Dr Ndiritu said coronary artery bypass grafting has been extensively studied, although one of the long-term challenges is the possibility of the new vessels becoming blocked.

Doctors therefore prefer to use a patient's own arteries where possible because they are less likely to become blocked.

The procedure can improve blood flow to the heart, allowing the heart muscle to function better and patients to resume their normal lives for many years.

The duration of the operation depends on the number of vessels that need to be bypassed.

For the 74-year-old patient, doctors performed four grafts. Generally, the actual operating time takes between three and five hours, with more complex procedures taking longer.

Prof Ninami explained that, unlike surgery performed using a heart-lung machine, the off-pump technique allows doctors to operate while the heart is still beating.

“The major advantage is with using the heart-lung machine, it may cause a brain stroke. So to eliminate that kind of complication, without using the heart-lung machine is good,” said Prof Ninami.

He said countries around the world are adopting the technique in an effort to reduce some complications associated with the use of the heart-lung machine.

In Japan, for example, about 65 per cent of coronary bypass procedures are performed using the off-pump technique, compared with about 20 per cent in the United States, according to Prof Ninami.

“I am trying to introduce this technique in Kenya because it is cheaper,” Prof Ninami added, advising patients experiencing symptoms such as chest pain to seek medical attention and undergo regular check-ups.

In some cases, doctors can treat blocked coronary arteries using a catheter-based procedure known as percutaneous coronary intervention (PCI), which does not require open-heart surgery.

However, this was difficult for the 74-year-old patient because he had disease affecting three coronary vessels.

“It is difficult to treat by the catheter treatment. So normally, internationally, we treat by the surgical treatment, which is the coronary artery bypass graft,” Prof Ninami explained.

The patient was also diabetic, a condition doctors said may have complicated his heart disease.

Dr Ndiritu said the goal of operating while the heart is still beating is to avoid some of the complications associated with stopping the heart.

“Fortunately, the blood vessels that we are working on are on the surface of the heart. So it is then technically possible to work because they are on the surface and there is not too much blood,” said Dr Ndiritu.

During the surgery, doctors placed a stabilising device on the surface of the heart to minimise movement in the specific area being operated on.

However, debate continues over whether to routinely use the heart-lung machine or perform surgery on a beating heart.

Dr Ndiritu said some centres that had adopted off-pump surgery had also returned to conventional surgery in some cases.

“So it is a new thing. It is a good thing. We are learning a new technology. We will find our place in the use of it,” he said. “When we bypass, it means we have to bring a new vessel for blood to flow to what we call the target vessel.”

After surgery, the patient is taken to the Intensive Care Unit for close monitoring before being transferred to a ward and eventually discharged.

The length of hospital stay depends on the patient's condition and response to treatment.

“The duration of the heart surgery really depends on the complexity of what you have to do. We try to work fast and minimise the disturbance on the heart,” said Dr Ndiritu. “The shorter the better, but then the job needs to be done well.”

Patients who undergo the procedure are placed on regular follow-up.

Dr Ndiritu said the human body has alternative blood supplies to many parts of the body, allowing doctors to safely harvest a vessel when necessary.

“Whether it is the artery or the veins, there's a lot of alternatives and we study and review a patient well before removal,” he said.

Patients with coronary artery disease generally first present to a cardiologist.

In the case of the 74-year-old patient, doctors said he had become increasingly tired because his heart was not receiving enough blood.

Further tests and review revealed that his coronary arteries were blocked.

“Coronary artery bypass is not what we have done very often in the past, but we believe when we look at the population, we have many people who are in their 50s, 60s, 70s,” Dr Ndiritu noted.

The surgery, he added, could become increasingly relevant as more Kenyans live into older age with heart disease.

The surgeries are being performed by specialists from Japan, the US, Sweden and Canada in collaboration with their counterparts at KNH.

The experts, working under the KIBOS Health International Foundation, arrived in Kenya over the weekend to volunteer their time, provide specialised equipment and offer free cardiac care to patients who might otherwise struggle to afford the procedures.