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.

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 5^th 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 9^th 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.

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 4^th POD. Slowly his drug support was reduced, de-lined and mobilized and discharged on 12^th 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