Surgeons at Cleveland Clinic Abu Dhabi have performed one of the world’s rarest heart surgeries, a quadruple valve replacement, in a 22-year-old Egyptian man with acute infective endocarditis caused by an infected tooth.

The four-hour operation, in which the patient’s four heart valves were replaced with tissue valves, was performed by a team of cardiothoracic surgeons including Rakesh Suri, MD, DPhil, and Gurjyot Bajwa, MD. The patient is now recovering well.

“Quadruple valve replacement surgeries are very rare,” says Dr. Suri, CEO of Cleveland Clinic Abu Dhabi. “Only a few heart centers in the world are equipped with the technology, sophisticated therapies and specialist physicians capable of preparing the patient for the operation, doing the surgery and getting the patient through the postoperative course. Cleveland Clinic Abu Dhabi is one of the few hospitals in the Middle East that can offer this type of surgery.”

The patient became ill after extraction of an infected tooth while visiting the United Arab Emirates in December 2017. Doctors in Dubai diagnosed him with pneumonia, but the infection rapidly spread throughout his body, including to all four heart valves, which became severely damaged.

In January 2018, he was transferred to Cleveland Clinic Abu Dhabi, where a multidisciplinary team of Heart & Vascular Institute surgeons, cardiologists, imaging specialists and other caregivers decided to proceed with quadruple valve replacement surgery despite its low survival rate.

“We studied the patient’s condition among a multidisciplinary team and told him this was a high-risk operation,” explains Dr. Bajwa. “But without it, he would not have survived.” She notes that factors in the patient’s favor included his lack of heart disease history and freedom from immune-compromising conditions.

The open procedure was done on cardiopulmonary bypass with the heart stopped for only 70 minutes. The order of valve replacement proceeded from aortic to mitral to pulmonary to tricuspid. “It was a time-critical, efficiently run operation, and that was the key to getting him off the table alive,” says Dr. Bajwa.

“The patient is making an impressive recovery, and his spirits are amazingly good, considering what he has been through,” says cardiologist Mahmoud Traina, MD. “He has been discharged from Cleveland Clinic Abu Dhabi and we are continuing with our follow-up care.”

“This is a remarkable operation,” observes A. Marc Gillinov, MD, Cleveland Clinic’s Chair of Thoracic and Cardiovascular Surgery. “Very few teams in the world could perform an operation of this complexity and achieve such a successful result.”