Starting a new Cardiac Surgery set up

The gratification and satisfaction of starting Heart surgery program post COVID was fraught with fears, apprehension and lot of queries in mind last June,2021. The team getting together, making the new management understand the exclusivities of Cardiac Surgery, training of new inductions all posed a big challenge. Today 9 months later looking back and analysing the zero mortality (100% success) achieved so far does look an uphill task but unimaginable too. There was no morbidity too and average length of stay hovered around 5.5 days. We took acute MI Cabgs, CABG +AVRs, poor lv functions and valve replacement surgeries coming to us in failure with saturations of 82%. Whole credit goes to in depth evaluation, stabilisation preoperatively to optimise for surgery, an intense post operative care by the most experienced team. There were sleepless nights to make patients sleep well and go back home in comfort and smiles on their faces.

I always say Programs are always bigger with teams and not mere buildings. An intentness to treat life and see them as humans surpasses any other expectation and brings laurels to our specialty and the profession.

Kudos to the team and thank God for His Choicest blessings on us and all my patients who showed faith in this new setup and in challenging times. Just to add one of the patients brother-in-law law of a dear family friend had to be induced in his presence in OT as he was jumping out of table being scared though having tight left main stem Coronary artery disease. But his brother-in-law’s presence worked and today he is a confident man riding the lift alone which he was scared to do preoperatively!! 

#surgery  #team #training #covid #success #management #coronaryarterydisease #cabg #sarwalheartsurgery #drsarwal

Substandard Cardiac Surgery Centres

All hospitals including the small nursing  home types like HH, MH here in tricity of Chandigarh aspire to have the most prestigious  speciality services of Cardiac Surgery with them which is not only  highly skill oriented but is very man power intensive if you want to save lives. This is the only speciality which gives you seconds to rescue a life in danger and help needs to be in house 24x7. Recently these over ambitious small setups have spoiled the stature of speciality in encouraging the younger generation Surgeons to work without back ups,  on refurbished equipment which thankfully Govt is banning them now, cheap reused disposables just for the sake of operating and inturn earning the meager bucks not bothering whether life will be saved or not. All kinds of unscrupulous means to earn extra money underhand even from Govt schemes are adopted in the name of viability knowing Honble Courts have nothing to offer as a quick relief. Years pass on to get small redressal.
This approach in highly critical and skilled speciality has destroyed the image of the speciality and the profession. Crowds gather on each mortality, police uses force still the show goes on.
NABH approvals have become another farce with hired team and hired equipments to fill the forms for approval.

My question is simple:
Can't the Govt ban  or bar these small funny setups from operating this highly skilled speciality or makes it mandatory to provide standardised care at these hospital cum nursing homes? It will go a long way to save many bread winners of the families and save huge avoidable losses of life!
#team #nursing #hospital #hospitals #work #money #power #surgery #cardiacsurgery #heartsurgery #drsarwal #sarwalheartivillage

End to end Heart care from comfort of patient's homes!

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www.sarwalheartivillage.com 

Will soon bring to you an all new platform for end to end heart care from the comfort of patient's homes.

18-yr underprivileged boy from Kashmir gets new lease of life at Max Super Specialty Hospital, Mohali

His free cardiac surgery was funded by Max India Foundation
CHANDIGARH: Partially deaf by birth, 18-year old Asif Wani sordid tale of despair and victory is heart rending. The sixth child of a daily laborer, Abdul Azeea Wani, Asif was brought to Max Super Speciality Hospital, Mohali with complaints of breathlessness and palpitation.

He was diagnosed with complex birth heart defects multiple conditions of Atrial septal defect, PDA and severe Pulmonary Stenosis (Congenital disorder) comprising of hole in the upper chambers of the heart, along with a flowing channel between main artery of the body and artery feeding the lungs which normally closes soon after birth. The surgery that saved the life of this innocent teenager was not only complex from the medical point of view but also gave a new lease of life to the hapless boy.
Asif’s mother Zareefa Bano was speechless with gratitude as her son narrated the story of their strife to get treatment for their son. Asif had been diagnosed with the multiple congenital heart defects as early as 2 months of his birth. His parents took him to the local doctors at Srinagar but were turned away due to lack of funds. Even the best hospital in Srinagar refused free treatment to the boy. The procedure to save him, the family was told, would cost lakhs of rupees, which was impossible for the destitute daily wager to collect. Through a common acquaintance, Max India Foundation took up the case and Asif was successfully operated upon by Dr. Virendar Sarwal, Senior Consultant, Cardiology at Max Super Speciality Hospital Mohali. The 5-hour surgery involved one week of post operative care under expert supervision of critical care experts.
Belonging to an obscure little village Handwara in the far reaches of Kupwara Distt about 10-12 Kms from LOC, Asif’s parents were devastated when they realized that he was suffering from congenital heart disease. Asif was advised immediate surgery. Helpless and penniless, Asif and his family were in a dilemma as to how they would bear the cost of such an expensive surgery. It was then that he was referred to Dr Sarwal, who volunteered to take up his case. Since Asif belonged to a poor family and his parents could not afford the expensive treatment, an acquaintance, who had been helping the family since last 2 years in arranging funds, approached Max India Foundation for financial assistance. Max India Foundation decided to help the young boy by bearing the entire cost of surgery and offering him world class medical treatment at Max Super Speciality Hospital.
Ever since Abdul Azeea Wani, Asi’s father lost his eyesight 5-6 years back, Asif’s mother has been working as a labourer on a meager daily wage with no other source of income. We have been running from pillar to post for 2 years but all efforts to secure funds for the surgery bore no fruit. Our fellow villagers managed to gather Rs 16000 for our travel and stay once they came to know that Max Hospital was helping us, said .
Dr. Sarwal said that since these were birth defects, these were high risk surgeries. Asif lungs had developed early hypertensive changes and it was a long on pump surgery because of three congenital defects. His pulmonary valve was too small for his age. Asif underwent intracardiac repair on Cardiopulmonary bypass at Max Super Speciality Hospital on October 14 and soon recuperated. He would be requiring regular medication to support his heart condition.
For the past 18 years, my world was full of just pain and helplessness, said an emotional Asif, while expressing gratitude towards Max India Foundation for their support With this crippling disease, all I could do was sit or lie down on my bed and take a few faltering, painful steps to go to the toilet. It was a very depressing state of affairs for my family and me and many times I would wonder what was the point of existing like this, he remarked.
Ms Mohini Daljeet Singh, Head, Max India Foundation said that living up to our social responsibility of an integral part of the core philosophy of Max India Foundation, we were very glad that we have been able to get an opportunity to serve the needy. We would continue doing so in the times to come with sincerity and passion, she asserted.
It may be mentioned here that under various CSR programs like immunization, health awareness and health camps, artificial limbs camp, palliative care for cancer patients, Max India Foundation has now crossed the 1435 free and subsidized surgeries mark. Over 477147 people have benefitted from the various CSR programmes of Max India Foundation till now.
Dr. Ashutosh Sood, GM operations at Max Super Speciality Hospital Mohali said that this whole package bearing cost of Rs 2 lacs, was done entirely free of cost. However, it was well worth it because today Asif presented a heartwarming sight. Having recovered very well, he was up and about, talking and playing like a normal teenager.. The joy on his face was priceless and nothing compared to the satisfaction of having helped tears turn into smiles, remarked Dr Sood.

High risk Octogenarian successfully treated for Coronary Artery Disease with Beating Heart Bypass Surgery successfully

 

·         Patient presented with critically blocked and calcified heart vessels which are difficult to tackle surgically

·         Off Pump Coronary Artery Bypass (OPCAB) or Beating Heart Bypass Surgery is a safe and proven option for bypass surgery in elderly patients

 3^rd September, Mohali: Elderly patients, compared with patients of a younger age group, present for surgery with a greater burden of risk factors and reduced functional levels. Short‐term outcomes are hence poorer in them. But symptomatic relief occurs in most patients and is accompanied by excellent rates of long‐term survival and a good quality of life when treated with beating heart surgery. Max super speciality Hospital Mohali recently treated an 84 year old male, Ramnarayan, who had his all three major heart arteries critically blocked. Along with this complication, the major arteries going to his brain were also blocked on both sides by 90% and 60%. The main artery on the left side of the heart (called left main ) was having 90% stenosis- in such critical conditions, bypass surgery becomes an urgent requirement. Also other three arteries, two on the left and one on right side were also blocked by 90% and 99%.

“He was very symptomatic” avers Dr Virendar Sarwal, Principal Consultant and Chief of Cardiac Surgery, his treating physician “Ramanarayan was offered high risk bypass surgery on beating heart at the time of angiography because of his age. In octogenarians, the risk to life becomes very high as all organs of the body are aging due to wear and tear. Reserves  are substantially low which make it difficult for the body to undertake the stress of surgery.”

Ramnarayan decided to take some time off and went home but had to get readmitted twice in the next 10 days because of severe heart symptoms. The family accepted the high risk  involved and the medical team collectively decided to work him up for surgery. “For this category of  patients  beating heart surgery which is now an  established technique  serves as very good  option . But, an individualized risk–benefit profile must be carefully constructed by clinicians, taking into account several different factors and not just age alone.

On investigations, it was found that Ramnarayan’s both carotid arteries (supplying blood to the brain) were also critically blocked and we had to take extra care to avoid brain damage during surgery especially because of acute blood pressure variations. His CT scan had dilated lateral ventricles and cerebral atrophy. As there was no evidence of any major stroke we decided to go ahead with beating heart bypass by taking special precautions in the OT. Three grafts were given to him on beating heart by using octopus stabilizer and maintained higher blood pressure intra operatively.”

Ramnarayan was fully mobilized  on 3rd day and discharged from the hospital on 5th day.

 

Discussing the advantages of off pump coronary artery bypass (OPCAB) or beating heart Bypass surgery as it is commonly called, Dr Sarwal said “ OPCAB is though technically demanding is a safe and prove option for high risk bypass surgery. Doing surgery on a beating heart eliminates the need for heart lung machine,  results in fewer side effects. Some potential benefits of beating heart surgery are lower risk of stroke, fewer problems with memory loss and thinking skills, reduced injury to the heart, fewer heart rhythm problems and shorter hospital stay, less ICU stay and less usager of blood. Long term success of OPCAB includes improvement or complete relief of their symptoms and being symptom-free for several years. They may recover from surgery more quickly than those who go "on pump" and they may suffer from fewer post-operative complications.”

FAILURE TO THRIVE, ONE YEAR, 6 KGS POST VP SHUNT FOR HYDROCEPHALUS AND ON ANTI TUBERCULOSIS TREATMENT OPERATED FOR VSD CLOSURE on pump.

Max Hospital, Mohali helps save life of a critically ill Poor Patient with Life Saving Heart Surgery

RP a 31years old gentleman presented to max hospital, Mohali with acute breathlessness, vomiting for last four days. He was having this problem for the last one years and was in the follow up of another hospital where he was diagnosed to be having leakage of both the major valves of heart  following fever and cough with expectation. For the last four days even he was not able to lie down flat in the bed because of severe breathlessness and heart failure. His liver was severely enlarged and his echo cardiograph showed  a dilated heart with severe leakage of one valve and moderate leakage in the other with a hole in the leaflet of one of the valve (aortic valve) with sign of vegetation  on it. He was on medical treatment with the other Institute before getting admitted under Dr Anurag Sharma Sr. Consultant Cardiology. He was put on decongestive treatment and echo here showed ruptured leaflet of aortic valve with severe leakage and liver was congested with fluid in the lungs. After two days of his treatment he was planned for valve replacement surgery .As he started responding to medical treatment he was shifted to the ward from ICU but as he was poor and was not able to afford surgical treatment which was required urgently for him, Max Hospital, Mohali decided to arrange finance for him through Max India foundation and they very graciously  arranged 1.2 lakh for him for the surgery with further contribution from the hospital. But a day later his condition worsened and he went into shock state because of congestive heart failure with his heart rate dropped to 30/per mint. His urine output also dropped and he went into renal shutdown. He was shifted back to ICU and had to be put on ventilator as an emergency and drugs started to maintain his B.P. Next day his condition improved and he started stabilizing under Doctor Anurag Sharma and this team.  With great efforts again he stabilized and was removed  from the ventilator  but still was  on medication to support his heart. After five days of aggressive treatment he was weaned of from all drugs but his liver functions were still deranged. As there was no other alternative he was planned for emergency surgery requiring replacement of both the valves as his echo showed second valve also leaking severely after this episode.  The case was renewed by Dr. Virendar Sarwal, In charge of Cardiac Surgery and his team and  a request for more funds was made to Max India foundation  and additional money was sanctioned for him. After four days of more stabilization and with improvement in liver functions he was taken for surgery with a plan to change the ruptured aortic valve and repair of  the mitral valve. On Trans Esophageal echo cardiograph in O.T it  was observed that the leakage in mitral valve is due to jet of leakage of the aortic valve and as such mitral valve was normal. Other factor for the leakage of this valve was dilated left chamber of  the heart. So it was planned that with the change of aortic valve the leakage of mitral will go down because the jet from aortic valve will disappear and dilatation of chamber will also go down. Under cardiopulmonary bypass his aortic valve was changed with a 22 sized mechanical valve by a team composing of  Dr.Virendar Sarwal, Incharge dept. of CTVS, Dr.Ajay Sinha, Cardiac Anesthesia, Dr. Aratatran Nahak , Dr Goswami, Dr Deepak Oberoi,  and Dr Rajit and after coming off CPB, TEE was done again which showed disappearance of the leakage of the other valve.He was shifted to ICU with moderate inotropics support and was weaned off from ventilator next day. He progressed very well in his post operative period and was discharge on the 5^th day from the hospital in a very stable condition. On first  follow up he is doing very well back to normal life after about a month of hospitalization and stormy course which could have been life threatening for him. Thanks to the untiring efforts of the whole team and a big help from Max India Foundation he is alive today.