Cardiac Surgery

HOD Message

The Heart Centre at AMRITDHARA, my Hospital, karnal is an integrated healthcare center with a highly experienced, qualified, and dedicated team of heart surgeons, cardiologists, and radiologists who work in complete coordination to provide comprehensive and multidisciplinary care to patients suffering from various heart ailments. At AMRITDHARA, my Hospital we have pioneered the ‘Heart Team’ approach to treating coronary artery disease. Our Heart Team approach ensures that the patient’s evaluation is done by a team of cardiac surgeons, clinical cardiologists, and interventional cardiologists so that the patient receives the benefit of comprehensive advice of the highest technical and ethical standard

Cardiac Surgery

As the ailments related to the heart have increased in the recent decade, people need to be in the care of a good cardiac surgeon. Surgery is a huge thing for anyone who is going through a medical situation. To make the process easier, the cardiac surgeon should be good enough to handle everything with ease and calm. With the advent of new technology and newer forms of surgeries, doctors are making themselves more educated. One such doctor is Dr. Ayush Srivastava who has pioneered in the field of cardiac surgery.

SPECIALITIES

  • Total Arterial  Bypass Surgery is a common surgery performed in India due to the blocked arteries. The surgeon replaces the blocked or damaged arteries with healthy ones to avoid any further problems.
  • Valve Repair/Replacement is a surgery that is done when someone’s Valves do not work properly. The doctor performs the surgery as it is needed and they can even go home in 4 to 5 days.
  • All other open Heart Surgeries

 

Major Procedures

  1. Coronary Artery Bypass Surgery (CABG)
  2. Heart Valve Repair/Replacement
  3. Other Open Heart Surgeries

1. Coronary Artery Bypass Surgery (CABG)

Overview

CABG is the most common type of heart surgery in India. Doctors called cardiothoracic surgeons to do this surgery.

Other Names for Coronary Artery Bypass Grafting

  • Bypass surgery
  • Coronary artery bypass surgery
  • Heart bypass surgery

CHD isn’t always treated with CABG. Many people who have CHD can be treated in other ways, such as with lifestyle changes, medicines, and a procedure called angioplasty  During angioplasty, a small mesh tube called a stent may be placed in an artery to help keep it open.

CABG or angioplasty with stent placement may be options if you have severe blockages in your large coronary arteries, especially if your heart’s pumping action has already been weakened.

CABG also may be an option if you have blockages in the heart that can’t be treated with angioplasty. In this situation, CABG is considered more effective than other types of treatment.

If you’re a candidate for CABG, the goals of having the surgery include:

  • Improving your quality of life and decreasing angina and other CHD symptoms
  • Allowing you to resume a more active lifestyle
  • Improving the pumping action of your heart if it has been damaged by a heart attack
  • Lowering the risk of a heart attack (in some patients, such as those who have diabetes)
  • Improving your chance of survival

You may need repeat surgery if the grafted arteries or veins become blocked, or if new blockages develop in arteries that weren’t blocked before. Taking medicines as prescribed and making lifestyle changes as your doctor recommends can lower the chance of a graft becoming blocked.

In people who are candidates for the surgery, the results usually are excellent. Following CABG, 85 percent of people have significantly reduced symptoms, less risk of future heart attacks, and a decreased chance of dying within 10 years.

 

( Total Arterial Bypass Surgery )

 

Types of Coronary Artery Bypass Grafting

Traditional Coronary Artery Bypass Grafting

This is the most common type of coronary artery bypass grafting (CABG). It’s used when at least one major artery needs to be bypassed.

During the surgery, the chest bone is opened to access the heart. Medicines are given to stop the heart, and a heart-lung bypass machine is used to keep blood and oxygen moving throughout the body during surgery. This allows the surgeon to operate on a still heart.

After surgery, blood flow to the heart is restored. Usually, the heart starts beating again on its own. In some cases, mild electric shocks are used to restart the heart.

Off-Pump Coronary Artery Bypass Grafting

This type of CABG is similar to traditional CABG because the chest bone is opened to access the heart. However, the heart isn’t stopped, and a heart-lung bypass machine isn’t used. Off-pump CABG is sometimes called beating heart bypass grafting.

Minimally Invasive Direct Coronary Artery Bypass Grafting

This surgery is similar to off-pump CABG. However, instead of a large incision (cut) to open the chest bone, several small incisions are made on the left side of the chest between the ribs.

This type of surgery mainly is used for bypassing the blood vessels in front of the heart. It’s a fairly new procedure that’s done less often than the other types of CABG.

This type of CABG isn’t for everybody, especially if more than one or two coronary arteries need to be bypassed.

Who Needs Coronary Artery Bypass Grafting?

Coronary artery bypass grafting (CABG) is used to treat people who have severe coronary heart disease (CHD) that could lead to a heart attack. CABG also may be used to treat people who have heart damage following a heart attack but still have blocked arteries.

Your doctor may recommend CABG if other treatments, such as lifestyle changes or medicines, haven’t worked. He or she also may recommend CABG if you have severe blockages in the large coronary (heart) arteries that supply a major part of the heart muscle with blood-especially if your heart’s pumping action has already been weakened.

CABG also may be a treatment option if you have blockages in the heart that can’t be treated with angioplasty.

Your doctor will decide whether you’re a candidate for CABG based on a number of factors, including:

  • The presence and severity of CHD symptoms
  • The severity and location of blockages in your coronary arteries
  • Your response to other treatments
  • Your quality of life
  • Any other medical problems you have

CABG may be done on an emergency basis, such as during a heart attack but results in such cases are debatable.

 

2.Heart Valve Repair/Replacement

Overview

Heart valve surgery is a procedure to treat heart valve disease. Heart valve disease involves at least one of the four heart valves not working properly. Heart valves keep blood flowing in the correct direction through your heart.

The four valves are the mitral valve, tricuspid valve, pulmonary valve and aortic valve. Each valve has flaps — called leaflets for the mitral and tricuspid valves and cusps for the aortic and pulmonary valves. These flaps open and close once during each heartbeat. Valves that don’t open or close properly disrupt blood flow through your heart to your body.

In heart valve surgery, your surgeon repairs or replaces the affected heart valves. Many surgical approaches can be used to repair or replace heart valves, including open-heart surgery or minimally invasive heart surgery.

Your treatment depends on several factors, including your age, your health, the condition of the affected heart valve and the severity of your condition.

Depending on the problem, there are a several different procedures for repairing or replacing valves.

1. Surgical valve repair

Surgical procedures are generally used for problems with the mitral or tricuspid valves.

  • Commissurotomy is a treatment for a tight valve. The valve flaps (leaflets) are cut to loosen the valve slightly, allowing blood to pass easily.
  • Annuloplasty is done for a leaky valve. There is a ring of fibrous tissue at the base of the heart valve called the annulus. To repair an enlarged annulus, sutures are sewn around the ring to make the opening smaller. Or, a ring-like device is attached around the outside of the valve opening to support the valve so it can close more tightly.
  • Valvulotomy is a procedure to enlarge narrowed heart valves. It can also be done with the help of a balloon.

2. Non-surgical valve repair

Percutaneous or catheter-based procedures are done without any incisions in the chest or stopping the heart. Instead, a thin flexible tube called a catheter is inserted into a blood vessel in your groin or arm and then threaded through the blood vessels into your heart.

  • Percutaneous or balloon valvuloplasty/valvotomy is used for stiffened or narrowed (stenosed) pulmonary, mitral or aortic valves. A balloon tip on the end of the catheter is positioned in the narrowed valve and inflated to enlarge the opening.
  • Percutaneous mitral valve repair methods – such as edge-to-edge repair – can fix a leaky mitral valve in a patient who is considered high risk for surgery. A catheter holding a clip is inserted into the groin and up into the left side of the heart. The open clip is positioned beyond the leaky valve and then pulled back so it catches the flaps (leaflets) of the mitral valve. Once closed, the clip holds the leaflets together and stops the valve from leaking.

3. Heart valve replacement

If your heart valve is too badly damaged to be repaired, surgery may be needed to replace it with a new mechanical or biological valve. Age is generally a factor in deciding which type to use – biological valves are generally preferred for older people. You and your doctor will discuss the options and decide which is best for you and your circumstances.

  • Mechanical valves made of long-lasting metals, carbon, ceramics and plastic were the first to be used in valve replacement surgery. They have been refined and improved since being introduced in the 1960s.
    • The major advantage of a mechanical valve is durability – they can last a long time.
    • A fabric ring is used to sew the valve to heart tissue.
    • Mechanical valves can lead to blood clots which may in turn cause a heart attack or stroke. To prevent clots, people with mechanical valves must take blood-thinning medications (anticoagulants) every day for the rest of their lives. This can have implications for women of childbearing age or for people who have a history of major bleeding. Depending on the type of blood thinners, you may require routine blood-testing to monitor your INR (international normalized ratio) to measure your blood’s tendency to clot.
    • A mechanical valve makes a soft clicking sound when it closes. This can bother some people.
  • Biological (also called bioprosthetic) or tissue valves are specially prepared natural valves that come from human donors or animals.
    • Animal source valves (a xenograph)  – usually cows or pigs – are similar to valves in the human heart. They are tolerated well and are less likely to form blood clots than mechanical valves.
    • Human heart valves from a donated heart (an allograft or homograft) are tolerated well and tend to last longer than animal valves. Using human valves is uncommon.
    • Valves can come from your own tissue (an autograft). In a Ross (or switch) procedure, your functioning pulmonary valve is used to replace your damaged aortic valve. Your pulmonary valve is then replaced with a donated one.
    • People with biological valves need to take blood thinners in the short term.
    • Biological valves are not as durable as mechanical valves. They are more durable in the aortic position and in older patients.

4. Minimally invasive valve repair and replacement

Unlike conventional surgery, minimally invasive surgery does not involve sawing through the breastbone and opening the chest. It doesn’t require stopping your heart or using a heart-lung machine. The surgeon watches your heart on a video screen and operates using long-handled surgical tools inserted through small incisions. In some cases, robotic arms are used. Minimally invasive valve repair and replacement is suitable for some types of valvular heart disease, but is only available in some hospitals. It may also be called endoscopic or robotic heart surgery.

    • Transcatheter aortic valve implantation (TAVI) is also called transcatheter aortic valve replacement (TAVR). TAVI is a minimally invasive surgical valve replacement procedure that is used to treat symptomatic aortic valve stenosis, with two key differences from traditional valve replacement surgery. Rather than opening up the chest, TAVI is done through small incisions in the groin or chest. Instead of repairing, or removing and replacing the damaged aortic valve, a new aortic valve is implanted directly on top of the damaged one.

    • The surgeon inserts a catheter containing a new, collapsible aortic valve through small incisions in the groin or chest.
    • Using ultrasound and chest x-rays, the catheter is guided to the correct position in the heart and the new valve is implanted and expanded.
    • Once the new valve is in place, it starts to control blood flow immediately.
    • People who undergo TAVI tend to recover faster and have shorter hospital stays (average three to five days) than people who have open-heart valve surgery.

TAVI is usually considered for people who are at high risk for complications from open-heart surgery. Your healthcare team will assess your symptoms and overall health to determine if TAVI is an option for you.

3. Other Open Heart Surgeries

Overview

Open-heart surgery, any surgical procedure that requires an incision into the heart, thus exposing one or more of the cardiac chambers, or requires the use of a heart-lung machine, a device that allows circulation and oxygenation of the blood to be maintained outside the patient’s body. The most-common open-heart procedures are for repair of valvular disease and for correction of congenital heart defects, chiefly septal and valve defects.

 

 

 

 

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AMRITDHARA, my Hospital
ITI Chowk, Karnal - 132001
Haryana, India

Phone Number

Front Desk: 0184-4098100, 9034749091
Emergency: 0184-4098539

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