Showing posts with label Bypass surgery. Show all posts
Showing posts with label Bypass surgery. Show all posts

Sunday, 8 September 2013

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
 3rd 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. Shortterm outcomes are hence poorer in them. But symptomatic relief occurs in most patients and is accompanied by excellent rates of longterm 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.”

Friday, 29 March 2013

Adding years to your Heart….Life beyond Heart surgery


Heart is the most important organ of body to sustain life….Adding life to heart means adding years to Life!” To Add life to your Heart now there is an Age-By-Age Guide  which help in bringing Small Changes, Big Results

         Every 39 seconds in the United States, someone dies from cardiovascular disease, according to the American Heart Association (AHA). Most of those deaths are completely preventable by working with your doctor to understand your own personal risks for heart disease, and then making a few changes in your health habits to lower those risks. The best health habits are those you adopt when you’re young and continue throughout your life, but it’s never too late to make changes that can protect your heart and help you live a happier, healthier life overall. Here, an age-by-age guide to getting -- and keeping -- a healthy heart.
         In Your 20s: Drink Water

Coming out of your teens, you may regularly drink soda, sports drinks or big glasses of juice. Switching at least one or two of these drinks a day to water will not only save you money, it may also save your heart. These drinks are the number one source of added sugar in the diet. The AHA recommends that women consume no more than 100 calories (6 teaspoons) of added sugar per day, and men no more than 150 calories (9 teaspoons). A single 12-ounce soft drink contains 130 calories, or about 8 teaspoons. Studies show that people who get a lot of their calories from added sugars often don’t consume enough fiber, calcium, iron, zinc and vitamin A in their diets. What’s more, drinking your “discretionary calories” is less satisfying than eating them, so you’re more likely to overeat, which may put you on the path to being overweight, having high blood pressure and being at higher risk for diabetes -- all dangers to your heart. If plain water is just too, well, plain, squirt a lemon or lime in it, drink seltzer or brew up some unsweetened iced tea.

         In Your 20s: Find a Better Stress Reliever
Now is the time to switch your bad habits to good ones. If you started smoking cigarettes as a way to fit in and look cool in your teens, and in your 20s you’re doing it to reduce stress, stopping smoking is the number one thing you can do for your heart. “People who smoke in their 20s and continue for the rest of their lives die on average 12 to 14 years younger than non smokers. “However, it’s easier to quit smoking in your 20s than it is later in life, because the habit is less ingrained. Any form of exercise is a better stress reducer than smoking, but people in their 20s might want to take advantage of their natural flexibility and try yoga.”

·        In Your 20s: Learn Your Family History

Now is the time to fill in the leaves on your family health tree. Talk to your parents and other relatives to find out what medical conditions run in your family. Although most people in their 20s aren’t at imminent risk of heart attack or stroke, your risks of these conditions might be much higher if a close relative experienced them at an early age. If your father had a heart attack before age 55 or your mother had one before age 65, or even if a grandparent, uncle or aunt had a heart attack or stroke at these young ages, you may be at increased risk and need to be doing everything possible now to protect your heart. You should also have your blood pressure checked every two years starting at age 18

·        In Your 30s: Set Post-Pregnancy Exercise Goals

These are prime weight-gaining years, especially if you are experiencing pregnancies. “Women get into a vicious cycle,”  “They’ll have a baby, gain 40 pounds and lose five. They’ll have another baby, gain 40 pounds and lose 10, and then by the end of their 30s, they turn around and they’ve gained 90 pounds. The 30s are when many women start taking care of everyone but themselves, but these are important years to keep weight under control, and it’s easier to lose weight in your 30s than when your metabolism starts slowing down in your 40s.” Set exercise goals to help you lose your excess weight between pregnancies. Purchase a baby jogger and jog every day. Set a goal to participate in a charity walk in a couple of months and start walking every day. In other words, move more in any way you can.

         In Your 30s: Do Something You Love Every Day

“Whatever activity makes you feel really good inside, make sure you do it for at least 15 or 20 minutes every day.”  “For some people it might be meditation, for others it’s running, and for others it may be reading. Whatever relaxes and restores you, carve out time each day to do it and it could become a habit for life.

·        In Your 30s: Know Your Numbers

By now you should be familiar with your “three Bs”: your body mass index, blood pressure and blood cholesterol. If any of your numbers are not in the target ranges for heart health, talk to your doctor about changes you can make to improve them. Here are the numbers you should aim for, according to the AHA:
-- Blood pressure: Less than 130/80 mm Hg.
-- Blood cholesterol: LDL (low-density lipoproteins, or “lousy cholesterol”) below 100 mg/dL; HDL (high-density lipoprotein, or “healthy cholesterol”) above 40 mg/dL for men and above 50 mg/dL for women;
-- Triglycerides: Below 150 mg/dL.
-- Body mass index: Healthy range is 18.6 to 24.9, with a waistline smaller than 35 inches for women, 40 inches for men.
·        Your 40s: Weight Train

“For women, the 40s are when your body starts losing a lot of its lean muscle tissue and metabolism slows, making you more likely to gain weight,”  “The AHA recommends women weight train at least two times a week, which can keep your metabolism up, strengthen your bones and help you look and feel great as you start heading toward menopause.”

         In Your 40s: Nurture Your Relationships

“By the time you’re in your 40s, you realize how important relationships become in helping you get through difficult times and in helping encourage you to make healthy choices in your life.”“If you haven’t already done it, now is the time to create and nurture that network of support around you. Research shows that people who are isolated in their 50s and 60s have more health problems than those who are surrounded by people who care about them.” Spend time with people you love and care about, whether it’s your spouse, children, siblings, friends, fellow members or other loved ones.
·        In Your 40s: Add Another Number

The AHA recommends having your blood glucose (sugar) level checked every three years beginning at age 45 to help monitor your risks for diabetes and heart disease. The recommended level on a fasting blood glucose test is less than 100 mg/dL. If yours is higher, talk to your doctor about ways to lower your risk for diabetes.

·        In Your 50s: Rethink When You Eat

The often-repeated advice to eat breakfast like a king, lunch like a prince and dinner like a pauper is especially true as you age into your 50s and beyond. “Most people need to eat fewer calories overall when they hit their 50s, and it’s best to eat most of your calories earlier in the day and not be locked into the idea that you need three big meals a day.” “You need calories early in the day to rev up your metabolism and give you energy for the things you need to do, and it’s fine to have a good-sized meal at lunchtime, but eating a lot in the evening may interfere with your sleep as your body works to digest the food. Most people in their 50s don’t need a lot of calories for the activities they do at night. Those extra calories that aren’t burned off just contribute to weight gain.”

·        In Your 50s: Volunteer

In your 20s and 30s, there tends to be a lot to be excited about -- marriage, babies being born, careers taking off. By the time you reach your 50s, those big life events may be in your past, and you may instead be facing an empty nest, parents who are dying or already gone and the denouement of your career. “Volunteering is a great way to bring more positives into your life.” “Whether it’s by starting a new group related to a cause you care about or helping out someone in your community, having something that you’re committed to can have a very positive impact on your life.”

·        In Your 50s: Get Screened

The National Osteoporosis Foundation recommends a bone mineral density test after age 50 if you have risk factors such as being menopausal or having a family history of osteoporosis. Although not directly related to your heart, “conditions that predispose to osteoporosis also predispose to heart disease -- namely, inactivity and poor diet,”  A bone mineral density test may pick up thinning bone problems that could predispose you to falls. If you fall, you may not be able to exercise for a while, which could set you up for weight gain and health problems. Strong bones help you have a strong heart.

·        In Your 60s and Over: Adjust Your Exercise to Accommodate Your Body

It’s important to maintain the momentum that you built up in your 30s, 40s and 50s. If you continue to be active into your senior years, your heart will look and act younger. In their 60s, some people start experiencing issues like arthritis and back pain, and you may have to switch from running to walking or from tennis to water aerobics. Find what works for you and keep doing it. Continue strength training twice a week, too. It will help you to maintain your lean body mass.

·        In Your 60s and Over: Take Up Yoga

Studies show that yoga not only helps you de-stress, it helps to prevent balance problems that can lead to falls in your later years. It also helps reduce pain if you have any chronic conditions, and improves sleep, all of which are good for your heart,”

·        In Your 60s and Over: Get Talking

Call your doctor at the first sign of any unusual symptom, even if you don’t think it’s serious. “In terms of heart disease, symptoms including chest pressure, tightness in your jaw, profound fatigue and shortness of breath with activity all may indicate heart problems.”  Your doctor may recommend more detailed screening to assess your risks, and, if necessary, treatment to help you live a longer, healthier life

Add Years to Your Life by new ways to protect against heart disease:

         Spice Up Your Meals..Indian masalas are full of antioxidants

         Eat a Handful of Nuts Daily

         Eat Fruit -- Especially Kiwis The kiwi’s lutein -- a plant compound that helps artery walls stay relaxed -- keeps your blood pressure down even when your stress levels climb.
         Hang Out with a Friend.. The Cleveland Clinic research suggests that nurturing a couple of solid friendships can cut your risk of heart disease by 40 percent…But No FB

         Eat Your Snack Mid-Afternoon.. Just trimming your waistline so it measures 34 inches or less -- even if you’re nowhere near your goal weight -- will cut your risk of heart disease by 72 percent. “Other fat stores -- like the stuff that gives people curvy hips and thighs -- just take up space, but belly fat produces a steady stream of heart-damaging inflammation,”

         Take Fish Oil Daily..Hundreds of studies document fish oil’s heart-protecting powers: Its omega-3 fats lower your liver’s production of triglycerides .

         Eat a Hearty Breakfast…Recent research shows moving most of your daily fat into your morning meal (and saving carbs for later in the day) reduces your production of artery-clogging triglycerides and prevents blood sugar surges -- two huge risk factors for heart disease. Eating fat first thing in the morning switches on your body’s natural ability to properly burn and   use all types of food -- so that far less of it ends up clogging your arteries and damaging your heart.

         Consider an Air Purifier..If you struggle with bad allergies to dust, mold or dander, getting your symptoms under control could cut your risk of heart disease by 30 percent or more.

         Tidy Up Your Home..Staying fit by getting roughly 30 minutes of light exercise daily can cut your risk of heart disease in half because exercise raises your production of artery-clearing HDL cholesterol by 10 percent or more. And you don’t have to lace up your sneakers to get this great health perk. In a surprising new study, the fittest women weren’t the ones exercising outdoors -- they were the ones with the cleanest houses!

         Sip Green Tea/Hibiscus Tea..When folks with heart-damaging high blood pressure sip 24 ounces of Green/Hibiscus tea daily, their pressure readings can plunge 13 points in six weeks. That makes this flavorful brew as powerful as ACE Inhibitors, a class of prescription drugs used to lower blood pressure
Another important factor is Stress as a risk factor towards heart disease. How One Can Make Intensive Changes to Manage Stress?

         Try directed breathing. Practice inhaling slowly and filling your belly, then exhaling and drawing your belly button toward your spine. You can also learn three-part breathing. Take in air smoothly, as a flowing inhalation from your abdomen, then your chest, and then your throat. Reverse the process as you exhale.

         Meditate. If you meditate daily, you will learn to focus on the present moment. Most people who meditate do so twice a day. When you concentrate on your breath or on a candle flame, for example, you clear your mind of thoughts and feelings that may get in the way of relaxation.

         Pray. Prayer allows you to turn your problems over to a higher power. When you trust in your faith, you realize that you may be guided by something bigger than yourself. This belief may help you to stick with your intensive lifestyle changes. 
         Try progressive muscle relaxation. This is a series of exercises that teach you to first tense and then relax your muscle groups. Starting with your toes and feet, work your way up, stopping at each body part. First tighten them, then relax them.

         Stretch. You may do any activity that gently extends the range of your muscles, tendons, and ligaments. You can start with these three moves. Raise your arms way above your head. Bend over, with your knees slightly bent, and reach for the ground so you feel a gentle stretch from your neck to your heels. Shrug your shoulders.

         Use visualization. This technique teaches you how to use your imagination to help reduce stress. You focus on a positive experience you have had or would like to have. For instance, visualize yourself on a beach. See the sun, hear the waves, feel the salty air on your skin. Or pick any time or place where you were truly relaxed and your breathing was calm. You can use this mental experience to achieve a new kind of peace.

         Try yoga. This ancient Indian practice involves breathing, relaxation, and stretching in a series of postures. 
If you have heart disease, a program of rehabilitation that is supervised by healthcare providers may help you do the following:

         increase your ability to engage in activity

         decrease your symptoms, such as chest pain, breathlessness, and fatigue

         improve your blood cholesterol levels

         get help to quit smoking, if you smoke

         reduce stress

         improve your psychological outlook

         reduce your risk of death from heart disease

Our country is slowly witnessing a  cardiac rehabilitation program which is a program designed to support you. Rehab staff work with you to:

         improve your diet

         increase your exercise

         change other habits that affect your heart 
         Healthcare providers trained to help you in these areas supervise the program. Cardiac rehab is meant to help you recover faster and return to a full, active life. This is true whether you have had a heart attack or heart surgery. It can also help if you've had another procedure, such as bypass surgery.

Sunday, 9 September 2012

CROSSED 100 MARK IN CARDIAC SURGERIES AT MAX HOSPITAL,MOHALI WITH 99.2% SUCCESS RATE

Crossed the 100 mark in cardiac surgeries at Max Superspeciality Hospital, Mohali. The profile of patients varied from one year to 80 years. CABG included the highest risk  situations tackled successfully. Started the paediatric cardiac surgery program with a complex blue baby who was corrected fully.
GREAT TEAM WORK WITH GREAT INFRASTRUCTURE COUPLED WITH VERY QUALITY ORIENTED ETHICAL APPROACH.

Friday, 13 July 2012

High Risk End stage Coronary Artery Disease treated successfully with Beating Heart Surgery


High Risk End stage Coronary Artery Disease treated successfully with Beating Heart Surgery

Recently we operated upon a 63 yrs old male who had CAD since last 10years and was very symptomatic as he had myocardial infarction or heart attack couple of times with the result his heart function went down to bare 15%. He was refused intervention every where in view if the high risk involved in it. Even his one of relatives in USA is a cardiologist and he also advised very high risk for surgery. He went into heart  failure a number of times and was treated at local hospitals for that. Looking at the heart function he was refused surgery but treated medically or was suggested PTCA in one of arteries with doubtful benefit..

                                                              He came to us again and on ECHO his ejection fraction was only 15%, dilated heart and muscle looked to be thin. His angiography done in NCR showed severe triple vessel disease. Dilated heart with low heart function makes it very high risk surgery. His “Euro score” a criteria to assess risk of surgery based on the clinical and investigative parameters was 14 indicating a mortality of 40%.We decided to do a further work up and went for PET scan(positron emission tomography) which gives us a very good idea that whether the heart muscle is viable or not and can it be revived by revascularization. Luckily for him PET showed good muscle with reasonably good viability in most of areas except two areas. Based on this we came to a conclusion that he will benefit if preoperatively he tolerates the procedure. We decided to offer him a beating heart surgery a new technique adopted with us for last 10years where you avoid heart lung machine and its side effects which is very crucial in such cases for good recovery. Intra-operatively we used special gadgets to monitor functioning of the heart continuously with continuous cardiac output catheter. Adequate preparation i.e. decongestion and putting intra-aortic balloon pump (IABP) preoperatively was done which helps heart in giving more blood. After 24hrs we took him for OPCAB(beating heart surgery) and did three by- passes on his heart. His lung pressures were very high which were manipulated with drugs and they settled down after the grafting. He sustained the procedure well and in the post operative period did very well. IABP was removed on 3rd day and all drugs to help heart were off by 5th post operative day. He was mobilised and shifted to HDU to see his early mobilization under close supervision. He was very comfortable in walking around extensively with normal parameters and was discharged on 9th day. Before discharge his heart function came up to 30% from 15% a massive improvement. It will further improve but slowly. These patients are ideally suitable only for heart transplant but facilities for this in our country are few and too expensive to maintain it also. If left untreated the prognosis is not very good as low output state and repeated heart failure damages the other organs like kidneys, liver and they succumb to multi-organ failure. Careful planning and extra care with new technologies help saving such lives and gives them quality of life also.

                                       Thus “Time is muscle and do not lose it in waiting.” By- pass surgery done at appropriate time in stable condition is the best thing to happen to heart and it increases your quality of life and prevents further set- backs to heart muscle. He was operated by a team headed by Dr Virendar Sarwal, In charge Dept. Of CTVS Max hospital, Dr Ajay Sinha, Dr Arat Nahak, Dr Srinivas, Dr Goswami, Dr Shailender at Max Superspeciality Hospital, Mohali.

Wednesday, 3 August 2011

Badly Damaged Heart Requiring Heart Transplant Treated Successfully With Beating Heart Surgery on IABP


Every heart attack leaves the heart muscle damaged and more the number of attacks, more the damage. After bypass surgery some part of its gets revived and some part remains damaged only. But major risk of damaged heat is whether it will be able to bear the stress of surgery and beyond a certain limit which is judged by echocardiography in terms of Ejection Fraction the risk is very high. These patients with Ejection fraction of 20% and below are generally the candidates for heart transplant which is itself is not very easy to go through because of shortage of donors especially in Indian setting and also because of life long  heavy expenditure on drugs. World wide in view of this there is an effort to salvage a few patients by offering their bypass surgery though mortality for these kinds of patients is very high but otherwise also it is same if nothing is offered to them.



Beating heart surgery has proved a blessing to such patients as success rates of bypass surgery in this class of patients has improved a lot. These patients but definitely require extensive investigation to see the benefit and thorough stabilization and planning. Sometimes before surgery they are supported with intra aortic balloon pump to reduce the load on the heart as well as improve the blood supply to heart muscle to some extent so that heart improves a bit to tolerate bypass surgery.



Recently, we at Alchemist Hospital, Panchkula operated upon one such patient Mr. Tara Chand 50yrs Male. Dr. V. Sarwal, Head, Deptt. of Cardiovascular and Thoracic surgery along with his team Dr. Mubeen Mohammed, Dr. Ajay Sinha, Dr. Amit Ahuja, Dr. Dheeraj Dumir, Dr. Srinivas and Mr. Des Raj operated upon him successfully.



He came to OPD for an opinion for his heart disease and his condition was getting worse. Earlier, he had shown at many places even had angiography done at Bangalore but some how could not get operated and as per his previous record his ejection fraction was 30%. He was advised fresh angiography followed by pass surgery. On the night before his scheduled day of angiography his condition deteriorated, had chest pain, breathlessness and went into heart failure. He was admitted in the night itself and angiography showed disease had progressed and other investigations revealed a fresh heart attack. He tolerated angiography but his blood pressure was low and required drugs to support it. Echocardiography revealed further damage to heart and ejection fraction fell down to 12%. It was decided to insert IABP (Intra-aortic balloon pump) to support the heart and then stabilize him with medications for next 48-72 his before planning for surgery.

   

Angiography showed two arteries 100% blocked and third one was 85% in the proximal part and after that 100% blocked so all three arteries were completely blocked and he was surviving on 2-3 small branches of these main arteries.



Review of all investigations showed that he was ideally a candidate of heart transplant and bypass was quite risky but this was an option only theoretically. His Trop –I levels a marker for fresh heart attack was high so we stabilized him with drugs to take out water from lungs. Supported him on IABP for 3 days and when Trop – I level came down we decided to go for beating heart bypass surgery. Only positive thing on the whole scenario was that he was admitted with chest pain along with breathlessness which in itself on indirect indication of revivable heart muscles.



He was taken to Operation Room for surgery after 3 days and three grafts were put on him on beating heart. His vessels had quite a diffuse disease and one of the vessels had to be thoroughly cleaned (Endarterectomy) before putting up the grafts. He tolerated the procedure with moderate drug support and ventilator was removed on next day and IABP on 4th POD. Slowly his drug support was reduced, de-lined and mobilized and discharged on 12th Post op day in very stable condition.

His echocardiography showed marked improvement on his second follow-up and EF has come up to 30% now. His recovery is very good and his normal routine has started now. Beating heart bypass surgery is also quite risky in such conditions but is much better and helpful than conventional bypass surgery done on heart lung machine. This single technique has made quite a bit of difference in the outcome of such patients and our center is expert in this technique and has offered successfully this to very high risk and elderly patients even above 80yrs of age